脑挫裂伤灶周围水肿区大小的变化及其影响因素分析

【摘要】目的分析引起不同区域脑挫裂伤灶周围脑组织水肿区体积差异性的因素，为治疗脑水肿提供相关理论基础。方法回顾性分析113例脑挫裂伤患者的资料，根据CT资料，分为皮层大静脉区域脑挫裂伤组（静脉组）47例、其他部位脑挫裂伤组（非静脉组）66例，应用3D-Slicer软件分别计算伤后第1次CT脑挫裂伤的体积、第5 d脑挫裂伤及周围脑组织水肿的体积，并计算脑挫裂伤灶与周围脑组织水肿体积的比率，统计两组脑挫裂伤灶进展病例数及手术病例数；同时比较入院后6 h内和第5 d的红细胞压积（Hct）、纤维蛋白原（Fg）及D-二聚体（D-D）差异。结果静脉组脑挫裂伤灶周围脑组织水肿比率明显高于非静脉组（P＜0.05），两组进展病例数及手术病例数，差异无统计学意义（P＞0.05）；两组间的Hct、Fg及D-D比较，无统计学意义；但总体样本比较，两次的Hct无差异，与入院后6 h内相比，第5 d的Fg明显升高，且有统计学意义；D-D稍下降，亦有统计学意义。结论皮层静脉回流障碍可能是脑挫裂伤引起周围水肿最大因素，轻-中型颅脑损伤后，短时间内Fg稍有下降及D-D达到最高值，之后Fg渐升高、D-D渐下降。

Abstract: ObjectiveTo analyze the factors causing the volume difference of edema area around brain contusion and laceration in different regions, and to provide relevant theoretical basis for the treatment of brain edema. MethodsThe data of 113 patients with cerebral contusion and laceration were analyzed retrospectively. According to the CT data, they were divided into 47 cases in the cerebral contusion and laceration group of cortical great vein(vein group) and 66 cases in the cerebral contusion and laceration group of other parts(non vein group). The volume of the first CT cerebral contusion and laceration after injury, the volume of cerebral contusion and laceration on the 5th day and the volume of surrounding brain edema were calculated by 3D-slicer software. The ratio of brain contusion and laceration focus to the edema volume of surrounding brain tissue was calculated, and the number of progressive cases and surgical cases of brain contusion and laceration focus in the two groups were counted. At the same time, the differences of hematocrit（Hct）, fibrinogen（Fg） and D-dimer（D-D） within 6 hours and 5 days after admission were compared. ResultsThe incidence of brain edema around cerebral contusion and laceration in venous group was significantly higher than that in non venous group(P<0.05). There was no significant difference in the number of progressive cases and surgical cases between the two groups(P>0.05). There was no significant difference in Hct, Fg and D-D between the two groups. However, there was no difference in Hct between the two times. Compared with 6 hours after admission, Fg on the 5th day was significantly higher and statistically significant. D-D decreased slightly, which was also statistically significant. ConclusionsCortical venous reflux disorder may be the biggest factor of peripheral edema caused by cerebral contusion and laceration. After mild to medium-sized craniocerebral injury, Fg decreases slightly and D-D reaches the highest value in a short time, and then Fg increases and D-D decreases gradually.