Analysis Of Related Factors Of PCA Blood Supply Area Cerebral Infarction Caused By Sever Traumatic Brain Injury

Objective:To investigate the clinicopathological features and prognosis of cerebral infarction in the blood supply area of PCA(posterior cerebral artery)caused by s TBI(sever traumatic brain injury)with tentorial incisional hernia,and to discuss the related risk factors and initially analyze the possible mechanism.To strengthen the understanding of the pathogenesis mechanism of PCA blood supply area cerebral infarction caused by s TBI,so as to reduce the risk of its occurrence and improve the treatment effect of s TBI.Research objects and methods:A retrospective study was conducted on 150 s TBI patients with tentorial hernia admitted to the Department of Neurosurgery of the First Affiliated Hospital of Hainan Medical University from December 2013 to December 2018.Of the 150 patients,there were 131 males and 19 females in this group,male to female was equal to seven to one.The patients were between 18 and 67 years old at the time of injury,with an average age of 41.5 years.Among the 150 s TBI patients,30 patients had cerebral infarction in the PCA blood supply area,including 27 males and 3 females.20 patients had Glasgow coma scale(GCS,Glasgow coma scale)score of 3-5,and 10 patients with a score of 6-8.Based on the patient’s gender,age,GCS score,blood pressure,blood sugar,activated partial thromboplastin time(activated partial thromboplastin time,APTT)and prothrombin time(prothrombin time,PT),platelet count(blood platelet,PLT),midline shift,circumcistern or basal cistern compression,subarachnoid hemorrhage,epidural hematoma,brain contusion with subdural hematoma,surgical conditions and other factors were retrospectively summarized,using the chi-square test,single factor analysis extract statistically significant clinical factors;Logistic regression analysis was further used to evaluate the correlation between various factors and the incidence of PCA cerebral infarction in the blood supply area.Glasgow outcome score(Glasgow outcome scale,GOS)was used to evaluate the prognosis of patients.Results:30 cases of cerebral infarction of the PCA blood supply area occurred in this group of 150 s TBI patients with transtentorial hernia(the incidence rate was 20%),of which 26 patients had cerebral infarction within 1 week after injury,3 patients within1~2 weeks,and 1 patient ≥2 weeks.The mortality of PCA blood supply area cerebral infarction group was 26.7%.Univariate analysis,the decompression time greater than6 hours,GCS ≤ 5 points,the disappearance of circumcisternal cisterna,contusion of brain with subdural hemorrhage,midline displacement greater than 15 mm,hypotension and hyperglycemia were significantly correlated with the occurrence of cerebral infarction in the PCA blood supply area.No relationship was found between PCA blood supply area cerebral infarction and Gender,age,APTT,PT,platelet count,subarachnoid hemorrhage,epidural hemorrhage.By multivariate logistic analysis,decompression time greater than 6 hours,brain contusion and laceration combined with subdural hemorrhage,hypotension were the independent risk factors for cerebral infarction in PCA blood supply area.Conclusion:VIDecompression time greater than 6 hours,GCS ≤ 5 points,ambient cistern disappearance,brain contusion and laceration combined with subdural hemorrhage,midline shift more than 15 mm,hypotension,high blood sugar,are the important risk factors for cerebral infarction in the PCA blood supply area caused by s TBI with transtentorial hernia.Decompression time greater than 6 hours,brain contusion and laceration combined with subdural hemorrhage,hypotension are the independent risk factor for PCA blood supply area cerebral infarction.Clinical rational evaluation and intervention of these factors may be conducive to the prevention of cerebral infarction in the PCA blood supply area,so as to improve the prognosis of patients.