Correlational Research Of The Risk Factors Of The Posttraumatic Cerebral Infarction

Objective: Discussing the risk factors associated with posttraumatic cerebral infarction after brain injury and to assess the prognosis.Methods: Discussing the risk factors associated with PTCI through a prospective study and a retrospective study.A prospective study:(1)Selected the eligible newly admitted patients(a total of 130 cases),collect venous blood within 12-24 h after injury,tested the coagulation function(platelets,PT,APTT,fibrinogen,D-dimer),plasma biochemistry(Na+,K+,Ca2+,HCO2-),white blood cell count,blood sedimentation rate,plasma viscosity,hematocrit,recorded patient demographics(gender,age,admission GCS score).(2)Examed the brain CT at admission,and re-examed the brain CT at 3d,5d,7d,while conventional treatment in accordance with the principles of our department for treatment,then recorded the patients with PTCI.(3)Simultaneously to all 130 cases taking the CT angiography examination and dynamic review the patients with abnormal CTA after treatment.(4)Recorded the number of patients and patients with PTCI in the scope of each section of indicators of blood test and the basic information,recorded the number of patients with different result of CTA,compared all the data above,and multivariate logistic regression analysed the high risk factor.(5)Recordd the patient with abnormal CTA and evaluated the change of their CTA after 2 weeks treatment,and then evaluated the effect of treatment to the PTCI patient after 2 weeks and 6 weeks.A retrospective study: The retrospective analysis of 592 cases of eligible traumatic brain injury patients treated in our department from January 2012 to January 2014,in whom 41 patients suffered PTCI.One-factor analysing the factors of the gender,age,admission GCS score,the type of brain injury(brain contusion,epidural hematoma,subarachnoid hemorrhage),brain herniation,craniotomy,the time of using hemostatic drugs,hypotension,infection associated with PTCI,and then multivariate logistic regression analysing the risk factor,and the prognosis were compared.Results: A prospective study:(1)130 patients,12 cases occurred PTCI,the incidence was 9.23%.(2)Low GCS score on admission,abnormal platelets,PT,APTT and fibrinogen,high D-dimer and high DIC score,abnormal HCO2-and high plasma viscosity had statistical significance to affect the occurrence of PTCI(p<0.05),and were the suspicious risk factor for PTCI.But low GCS score on admission(OR 2418.539,95%CI 1.182-4947063.228,p < 0.05),platelet abnormalities(OR 1453.894,95%CI 2.611-809679.718,p<0.05),PT anomalies(OR 1184.697,95%CI 2.610-537768.83,p<0.05),D-dimer increased(OR 169.882,95%CI 3.214-8978.776,p<0.05)and high DIC score(OR 147.558,95%CI 2.096-10385.975,p < 0.05)were closely related to the occurrence of PTCI.(3)Vascular thin,vascular compression,bureaucratic narrow(closed)easily leaded PTCI(p<0.05).(4)The overall result of the review of CTA changed to the first abnormal CTA after 2 weeks treatment(p<0.05),the most recovery was the patient with vascular compression.(5)there was no different of PTCI patients after two weeks and six weeks treatment(p>0.05).A retrospective study:(1)592 patients,41 cases occurred PTCI,the incidence was 6.93%.(2)admission GCS score,the type of brain injury,brain herniation,the time of using hemostatic drugs,hypotension,infection had statistical significance to affect the occurrence of PTCI(p<0.05),and were the suspicious risk factor for PTCI.But low GCS score on admission(OR 18.023,95%CI 5.076-63.992,p<0.05),cerebral contusion(OR 43.265,95%CI 8.082-231.605,p < 0.05),brain herniation(OR 14.221,95%CI 2.874-70.374,p<0.05),and hypotension(OR 5.401,95%CI 1.066-27.358,p<0.05)were closely related to the occurrence of PTCI.(3)PTCI lead to severe disability(78.05% vs 28.49%)and mortality(9.76% vs 2.36%)of the patients were significantly higher than non PTCI patients(p<0.05).Conclusion: A Prospective study: low GCS score on admission,platelets and PT anomalies,D-dimer increased and high DIC scores were high risk factors for the occurrence of PTCI,they should be actively prevent.Vascular thin,vascular compression,bureaucratic narrow(closed)easily leaded PTCI,through the early prevention of intracranial vascular compression,PTCI would be prevented in a certain extent.If PTCI occured,there was a poor respons to treatment.A retrospective study: low GCS score on admission,brain contusion,brain herniation,hypotension were high risk factors for PTCI.Once PTCI happened,it would show the poor prognosis.