摘要
目的分析颅脑外伤患者颅内血肿清除术后并发对侧硬膜外血肿危险因素,以便为临床诊疗提供依据。方法回顾性分析2014年01月至2017年01月在我院接受急诊颅内血肿清除术治疗的颅脑外伤患者的,依据患者术后24h内是否并发手术区对侧硬膜外血肿分为观察组(并发手术区对侧硬膜外血肿)和对照组(未并发血肿),并比较所有患者术前一般临床资料,分析颅脑外伤患者急诊颅内血肿清除术后并发手术区对侧硬膜外血肿的危险因素。结果共纳入90例患者,其中观察组患者45例,对照组45例。单因素分析显示:观察组患者入院时昏迷状态、Babinski征阳性、合并脑挫伤、合并颅骨骨折、合并脑疝、术前中线偏移≥1cm、基底池受压、手术去除骨瓣比例显著高于对照组(P<0.05);观察组患者术后手术时间、GCS评分显著低于对照组(P<0.05);观察组患者舒张压、血浆凝血酶时间(thrombin time,TT)显著高于对照组。Logistic多因素回归模型分析显示:颅骨骨折、合并脑疝、中线偏移≥1cm、去除骨瓣、术后手术时间、GCS评分高低是颅脑外伤患者急诊颅内血肿清除后并发对侧硬膜外血肿的独立危险因素。结论外伤性颅脑损伤患者血肿清除术后并发手术区对侧硬膜外血肿患者入院时通常为颅内占位效应明显且多合并颅骨骨折的重型颅脑损伤,合并脑疝、中线偏移≥1cm、手术去除骨瓣、手术时机短、GCS评分低、TT时间延长是外伤性颅脑损伤术后并发对侧硬膜外血肿的高危因素,对于合并高危因素的外伤性颅脑损伤患者术后应当更加注意预测发生对侧硬膜外血肿机率。
Objective Our retrospective study was aimed toanalyze the risk factors of lateral epidural hematoma after craniocerebral trauma operation.Methods Clinical data ofcraniocerebral traumapatients with Emergency intracranial hematoma removal treatment at our hospitalfrom January 2014 to January 2017 was retrospectivelyanalyzed.Results A total of 90 patients were retrospective analyzed.45 patients developed lateral epidural hematoma（observation group）and 45 patients did not develop lateral epidural hematoma（control group）.The logistic regression analysis showed that a skull fracture,merging,cerebral hernia,midline shift 1 cm or more,removal of bone flap,operation time,GCS score,TTwere the independent risk factors of craniocerebral traumapatients with lateral epidural hematoma.Conclusion Patients with lateral epidural hematoma after craniocerebral trauma operation in hospital usually have severe craniocerebral injury with intracranial occupying effect and multiple intracranial fractures.Skull fracture,merging,cerebral hernia,midline shift 1 cm or more,removal of bone flap,operation time,GCS score,TT were the independent risk factors of craniocerebral traumapatients with lateral epidural hematoma.More attentions should be paid on craniocerebral traumapatients who undergo craniocerebral trauma operation and combined risk factors in the aim to prevent the lateral epidural hematoma.
作者
张檀
盛敏峰
Zhang Tan;Sheng Min feng(The Second affiliated hospital of Soochow universit)
出处
《立体定向和功能性神经外科杂志》
2018年第2期114-117,共4页
Chinese Journal of Stereotactic and Functional Neurosurgery
关键词
颅脑外伤
对侧硬膜外血肿
术后并发症
血肿清除术
危险因素
craniocerebral trauma
lateral epidural hematoma
postoperative complications
intracranial hematoma removal
risk factors
