Clinical Analysis Of Related Risk Factors Of Post-traumatic Cerebral Infarction Secondary To Craniocerebral Injury

Objective:Post-traumatic cerebral infarction(PTCI)after traumatic brain injury(TBI)is one of the most serious secondary damage in the event of will seriously affect the prognosis of patients with TBI,serious adverse effects on the patients’live and life,but its clinical manifestations of the lack of specificity,lagging conventional imaging findings,laboratory examination results confounding factors more,not for PTCI diagnosis in time.The aim of this study is to explore the clinical risk factors of traumatic post-cerebral infarction secondary to craniocerebral injury in order to provide an effective evidence-based diagnosis for the clinic.It is expected to guide the clinical evaluation of post-traumatic cerebral infarction secondary to craniocerebral injury,prevent and cure the occurrence of post-traumatic cerebral infarction,and improve the quality of life of patients.Methods:Clinical data of emergency surgical department’s patients admitted to due to craniocerebral trauma from January 2019 to December 2020 were selected.Patients with craniocerebral trauma were screened according to inclusion and exclusion criteria.According to whether there was secondary traumatic cerebral infarction,they were divided into PTCI group and non-PTCI group.Gender,age,Glasgow Coma Scale at admission,multiple injuries,cerebral herniation,cerebral contusion,subdural hematoma,brain stem injury,traumatic subarachnoid hemorrhage,cranial fracture,pulmonary infection,diabetes,smoking,drinking,hypotension,fever,platelet count,fibrinogen,and D-dimer,disseminated intravascular coagulation score,activated partial thromboplastin time,prothrombin time,international normalized ratio,the fibrinogen degradation products,platelet count,red blood count,red blood cell specific volume and dehydration drug hospitalization time,discrepancy quantity balance,and whether surgery,using SPSS26.0software for single factor analysis and binary Logistic regression analysis.Binary Logistic regression model was established and evaluated.Results:A total of 290 patients were enrolled,including 232 males(80%),135 patients(45.9%)who were injured in traffic accidents,34 patients(11.7%)who died,a mean age of 49 years(18.1 years),a mean admission GCS score of 11(8-14 points),and 19 patients(7.0%)who were diagnosed with post-traumatic cerebral infarction.Univariate risk analysis suggested that GCS score,cerebral herniation,subdural hematoma,pulmonary infection,fever,duration of medication for dehydration,platelet count,D-dimer,and prothrombolin time were related risk factors for traumatic brain injury complicated with traumatic cerebral infarction(P<0.05),PTCI group and non-PTCI in gender,age,multiple trauma,brain contusion,brain stem injury,traumatic subarachnoid hemorrhage,cranial fracture,diabetes,smoking,drinking,hypotension,fibrinogen,disseminated intravascular coagulation score,activated clotting time live enzymes,international standardization ratio,fibrinogen degradation products,red blood cell count,average deposited and discrepancy quantity balance of red blood cells,there was no statistically significant difference whether surgery(P>0.05).Binary Logistic regression analysis showed that subdural hematoma(P=0.006,OR=1.50,95%CI:1.039-1.585),duration of dehydration(P=0.005,OR=5.19,95%CI:4.329～5.820)and the reduction platelet count(P=0.024,OR=0.600,95%CI:0.148～0.875)were independent risk factors for the occurrence of post-traumatic cerebral infarction.There was significant difference in prognosis scores between PTCI group and non-PTCI group at discharge(P<0.01).Binary Logistic regression model was established,and the model coefficients were tested by mixed test(χ~2=41.064,P<0.01),Hosmer-Lemshow test(χ~2=11.970,P=0.153)and ROC curve test(AUC=0.902,P<0.01,95%CI:0.838-0.966),which indicates that the model has high goodness of fit and good identification.Conclusion:GCS score on admission,brain herniation,subdural hematoma,pulmonary infection,fever,dehydration drug use time,platelet count,D-dimer,prothrombin time were the factors that affected the happening of TBI secondary PTCI.Among them,subdural hematoma,treatment time of dehydration and the reduction platelet count were independent risk factors for PTCI secondary to TBI.If clinical symptoms,signs or laboratory findings are found to be difficult to fully explain by the current diagnosis,attention should be paid to the possibility of secondary traumatic cerebral infarction to help patients have a better prognosis.