Risk Factors For Cerebral Infarction Secondary To Severe Traumatic Brain Injury And Prevention Strategies

Objective: To understand the general clinical features of PTCI with s TBI. To understand the prognosis of PTCI patients. To explore the risk factors related to PTCI secondary to severe traumatic brain injury. To discuss the strategies of prevention and treatment of post traumatic cerebral infarction. In order to reduce the incidence of PTCI in patients with severe craniocerebral injury and improve the prognosis of patients with severe traumatic brain injury.Methods : A retrospective review of 186 severe TBI patients admitted to our department between January 2013 and October 2014 was performed. 1.To count numbers of patients with PTCI from 186 patients with severe craniocerebral injury and understand the incidence of severe traumatic brain injury. To record the number of cases appeared in a time period that PTCI occurs and exame the characteristics of the time PTCI appeared. Site location of PTCI infarct.2.To evaluate prognosis of patients with PTCI after half year by telephone follow-up、home visits and reading clinical datas accordiong to Glasgow outcome scale. 3.Single factor analysis was performed using chi-square test to find the possible risk factors.Multivariate analysis was performed using logistic regression to identify independent risk factors for the development of PTCI. 4.To discuss the strategies of prevention and treatment of traumatic cerebral infarction from risk factors of PTCI and clinical experience in diagnosis and treatment of patients with PTCI in neurosurgery department of the first affiliated hospital of wannan medical college.Results:1.31 cases appears post-traumatic cerebral infarction in 186 patients with severe craniocerebral injury, the incidence rate was 16.67%. Incidence rate of Glasgow score 3 ~ 5 was 23.53%(20/85), GCS score ranged from 6 to 8 with the incidence of PTCI was 10.89%(11/101). PTCI appeared at 7 days after injury within 12 cases(38.7%), 8 to two weeks in 14 cases(45.2%), 15 days to January, 5 cases(16.1%).In 31 patients with PTCI,the infarct locate in the area simply supplied by the anterior artery is7 cases,posterior cerebral artery is 7 cases,middle cerebral artery is 3 cases. Distribution in the brain anterior and middle cerebral artery territory at the same time are 6 cases,infarction distribution in the middle cerebral artery and posterior cerebral artery infarction are 8 cases, distribution in three blood supply area at the same time are 2cases.2. To Patients with PTCI, the mortality rate was 22.58%(7/31), severe disability rate was 32.26%(10/31), mild disability rate was 16.13%(5/31) after half year. The patients with PTCI appears poor prognosis compared with patients without traumatic cerebral infarction.3. Low GCS,low blood pressure or shock, t SAH,cerebral contusion(hematoma),subdural hematoma,cerebral hernia,basal skull fracture,and decompression craniotomy are related to PTCI in patients with s TBI(P<0.05). No association is observed between PTCI with epidural hematoma, a lot of dehydrating agent use, gender or increasing age(P>0.05).Conclusion: 1. The incidence rate of PTCI in severe craniocerebral injury was16.67%. Incidence rate of Glasgow score 3 ~ 5 was 23.53%,GCS score ranged from 6to 8 with the incidence of PTCI was 10.89%.2. PTCI significantly affects the prognosis of patients with severe craniocerebral injury.3. Low GCS,low blood pressure or shock, t SAH,cerebral contusion(hematoma),subdural hematoma,cerebral hernia,basal skull fracture,and decompression craniotomyare risk factors for PTCI in patients with s TBI. No association is observed between PTCI with epidural hematoma, a lot of dehydrating agent use, gender or increasing age.