外伤后急性弥漫性脑肿胀的相关危险因素及护理.doc

外伤后急性弥漫性脑肿胀的相关危险因素及护理 邬幼萍 张春雷 王玉海 刘其芹* 全军颅脑损伤救治中心，解放军第101医院神经外科一区，江苏无锡 214044 【摘要】 目的 通过对外伤后急性弥漫性脑肿胀的临床流行病学调查，分析其相关危险因素，为制定针对性护理措施提供依据。方法 对外伤性急性弥漫性脑肿胀（PADBS）患者可能的10个危险因素（性别、年龄、受伤至入院时间、着力部位、误吸、低血压、高血压病史、原发脑干伤、合并多发伤、颅底骨折）行Logistic回归分析。结果 原发脑干伤、有无低血压、着力部位（枕部）、误吸是PADBS的危险因素，高龄是PADBS的保护因素。结论 护士应关注PADBS的相关危险因素，加强呼吸、循环系统监护，减少误吸，正确实施液体疗法等措施尽量减少PADBS发生。 【关键词】 外伤性急性弥漫性脑肿胀；危险因素；护理；Logistic； Risk factors and nursing interventions for Posttraumatic Acute Diffuse Brain Swelling WU You-ping, ZHANG Chun-lei, WANG Yu-hai, LIU Qi-qin.Craniocerebal injury cure center of PLA, Department of Neurosurgy, 101st Hospital of PLA, Wuxi 214044,China 【Abstract】 Objective To analyze the risk factors of posttraumatic acute diffuse brain swelling (PADBS), provide the evidence for the corresponding care strategies through the epidemiological survey. Methods Ten possible risk factors of posttraumatic acute diffuse brain swelling ( Gender, age, time from injured to enter hospital, force position, aspiration, hypotension, history of hypertension, primary brainstem injury, united injury, the presence or absence of basicranial fracture) were analyzed by logistic regression analysis. Results Primary brainstem injury，hypotension, force position, aspiration, and age were closely correlated with the occurrence of PADBS . Conclusion Nurses should concern about the risk factors associated with acute traumatic diffuse brain swelling. The incidence of acute traumatic diffuse brain could be reduced through monitoring the respiratory and circulatory system, reducing aspiration, and developing the correct fluid therapy. 【Key words】Posttraumatic acute diffuse brain swelling；Risk factors；Nursing care；Logistic； 外伤性急性弥漫性脑肿胀（PADBS ）是指外伤后脑组织广泛肿大或膨胀，CT表现为双侧或单侧大脑半球肿胀，可单独存在或与各种类型颅脑损伤同时并存，是影响脑外伤患者预后的重要因素之一，多数发生于伤后4～14小时，最早可发生在伤后20～30分钟。国内外目前对PADBS的研究多集中于发病机制及预后的探讨，而有关PADBS的临床流行病学调查及相关危险因素和护理对策研究，国内外鲜见报道。现对355例颅脑损伤患者的临床资料进行回顾性分析，探讨PADBS的危险因素，并为临床针对性护理提供依据。 1 资料与方法 1.1 一般资料 收集2007年1月至2011年8月收治的颅脑损伤中发生PADBS的54例患者及同期入院未发生P