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目的分析创伤性脑损伤患者颅内进展性出血的临床特征及危险因素。方法非手术创伤性脑损伤患者103例,根据颅内出血进展情况分为进展组(n=46)和非进展组(n=57)。比较两组患者的年龄、格拉斯哥昏迷评分(GCS)、受伤至首次CT检查时间(HCT1)、受伤至第二次CT检查时间(HCT2)、入院时凝血功能指标、首次及复查CT血肿量。采用Logistic回归分析颅内进展性出血的危险因素。结果两组患者的年龄、GCS、HCT1、凝血酶原时间(PT)、国际标准化比率(INR)、纤维蛋白降解产物(FDP)、D-二聚体(D-D)、血小板(PLT)计数及复查CT血肿量的差异有统计学意义(P<0.05)。Logistic回归分析显示,年龄、FDP、INR和D-D为颅内进展性出血的危险因素(OR>1,P<0.05);GCS、HCT1和PLT计数值较低的患者发生颅内进展性出血的可能性较大(OR<1,P<0.05)。结论对于创伤性脑损伤患者,年龄、FDP、INR和D-D为颅内进展性出血的危险因素;对GCS、HCT1和PLT计数值较低的患者应加强监护。
Objective To analyze the clinical characteristics and risk factors of intracranial progressive hemorrhage in patients with traumatic brain injury. Methods 103 patients with non-surgical traumatic brain injury were divided into progressive group (n = 46) and non-progressive group (n = 57) according to the progress of intracranial hemorrhage. The age, Glasgow Coma Scale (GCS), time from injury to first CT examination (HCT1), time to injury to second CT examination (HCT2), coagulation function at admission and CT hematoma volume were compared between the two groups. Logistic regression analysis of the risk factors for intracranial progressive bleeding. Results The age, GCS, HCT1, PT, INR, FDP, PL, PLT count and review CT hematoma volume difference was statistically significant (P <0.05). Logistic regression analysis showed that age, FDP, INR and DD were the risk factors for intracranial hemorrhage (OR> 1, P <0.05). The patients with GCS, HCT1 and PLT were likely to have progressive intracranial hemorrhage Sex is greater (OR <1, P <0.05). Conclusions Age, FDP, INR, and D-D are risk factors for progressive intracranial hemorrhage in patients with traumatic brain injury. Patients with lower GCT, HCT1, and PLT counts should be monitored intensively.