Analysis Of The Risk Factors For Progressive Cerebral Contusion And Laceration

Objective:To explore the high-risk factors for the early development of progressive cerebral contusion and laceration in patients.The analysis of related risk factors may provide a theoretical basis for early intervention and treatment,so as to improve the treatment rate of patients.Methods:The patients with brain contusion and laceration adminstrated in Suining Central Hospital from January 2017 to January 2019 were collected.Inclusion criteria:（1）A clear history of traumatic brain injury;（2）The first CT examination should be performed within 8 hours after the injury,and CT should be reviewed within 24 hours;（3）A clear indication of brain contusion and laceration on the first CT examination after admission.Exclusion criteria:（1）Patients with severe primary brainstem injury,severe organ injury and severe hemorrhagic shock after admission;（2）Patients with previous basic diseases such as hyperlipidemia,diabetes;（3）Insufficient clinical and imaging data complete patients;（4）Under the age of 18 or pregnant women;（5）Emergency craniotomy was required after admission;（6）History of anticoagulation therapy in the past 3 months.A total of 149 patients met the criteria.The patients were divided into progressive group and non-progressive group according to the progress of the disease.The progression of the disease was defined as:CT re-examination showed enlarged brain contusion and laceration,new brain contusion and laceration and new intracranial hematoma in other parts,and the increased volume was more than 30%of the volume of the first CT examination.The collected indicators included:gender,age,blood pressure,GCS（Glasgow Coma Score,GCS）decline（4-6h after admission）,re-examination of the head CT time,Aspartate aminotransferase（AST）,Alanine aminotransferase（ALT）,Creatinine（CRE）,Prothrombin time（PT）,Activated partial thromboplastin time（APTT）,Systemic Immune-inflammation Index（SII）,neutrophil/lymphocyte（NLR）,serum potassium levels.The collected factors were analyzed by univariate analysis and multivariate Logistic regression analysis.Results:Univariate analysis results suggested that gender,GCS decline（4-6h after admission）,ALT,AST,SII,NLR,serum potassium levels were closely related to the progression of brain contusion and laceration.There were no statistically significant differences in systolic and diastolic blood pressure,age,re-examination of the head CT time,serum creatinine,PT and APTT when the patients were admitted to the hospital.Multivariate logistic regression analysis indicated that admission GCS decline（4-6h after admission）≥2（OR=5.243;P<0.05）,SII≥2.02×10¹²/L（OR=2.644;P<0.05）,and serum potassium level<3.0mmol/L（OR=1.183;P<0.05）were independent risk factors for progressive brain contusion and laceration.Conclusion:GCS decline（4-6h after admission）≥2,SII≥2.02×10¹²/L,and serum potassium<3.0mmol/L were independent risk factors for progressive cerebral contusion and laceration.If clinicians found that the hospitalized patients had related risk factors,Attention should be paid to early re-examination of CT,close observation of changes in the condition,in order to adjust therapeutic strategies for patients in time.