摘要
目的分析重型颅脑损伤(sTBI)患者开颅血肿清除术后迟发性颅内血肿的影响因素。方法选取2014年2月—2017年4月南京医科大学附属江苏盛泽医院收治的行开颅血肿清除术的sTBI患者120例,其中术后72 h内发生迟发性颅内血肿35例(观察组),未发生迟发性颅内血肿85例(对照组)。记录本组患者迟发性颅内血肿发生情况及其预后,比较两组患者临床特征,sTBI患者开颅血肿清除术后迟发性颅内血肿的影响因素分析采用多因素Logistic回归分析。结果 (1)本组患者迟发性颅内血肿发生率为29.2%(35/120)。随访6个月,35例迟发性颅内血肿患者中恢复良好18例(占51.4%),中度残疾8例(占22.9%),重度残疾5例(占14.3%),长期昏迷3例(占8.6%),死亡1例(占2.9%)。(2)两组患者性别、年龄、民族、婚姻状况、文化程度、家庭月收入<5 000元者所占比例、医疗费用支付方式比较,差异无统计学意义;两组患者发病至手术时间、蛛网膜下腔出血发生率、颅骨骨折发生率、Babinski征阳性者所占比例、凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)、舒张压、收缩压、手术时间、血小板计数及格拉斯哥昏迷量表(GCS)评分比较,差异有统计学意义。(3)多因素Logistic回归分析结果显示,发病至手术时间[(1.261,1.808)]、颅骨骨折[,95%CI(1.172,1.622)]、Babinski征阳性[,95%CI(1.263,1.721)]、,95%CI(1.005,1.654)]是sTBI患者开颅血肿清除术后迟发性颅内血肿的独立影响因素。结论 sTBI患者开颅血肿清除术后迟发性颅内血肿发生率较高、患者预后较差,而发病至手术时间、颅骨骨折、Babinski征阳性、TT是sTBI患者开颅血肿清除术后迟发性颅内血肿的独立影响因素,应引起临床重视。
Objective To analyze the influencing factors of delayed intracranial hematoma after craniotomy for hematoma evacuation in patients with severe traumatic brain injury(sTBI).Methods We selected 120 patients with sTBI who were treated with craniotomy for hematoma evacuation from February 2014 to April 2017 in Jiangsu Shengze Hospital Affiliated to Nanjing Medical University,with 35 cases of delayed intracranial hematoma within 72 hours after operation(served as observation group)and 85 cases of no delayed intracranial hematoma(served as control group).The occurrence and prognosis of delayed intracranial hematoma were recorded.The clinical characteristics between the two groups were compared.The influencing factors of delayed intracranial hematoma after craniotomy for hematoma evacuation in patients with sTBI were analyzed by multivariate Logistic regression analysis.Results The incidence of delayed intracranial hematoma was 29.2%(35/120).Follow-up for 6 months showed that,18 out of 35 patients with delayed intracranial hematoma recovered well(51.4%),8 with moderate disability(22.9%),5 with severe disability(14.3%),3 with long-term coma(8.6%)and 1 with death(2.9%).There was no significant difference between the two groups in gender,age,nationality,marital status,educational level,the proportion of patients with monthly income less than 5 000 yuan and payment of medical expenses(P>0.05);there were significant differences in the onset-to-operation time,incidence of subarachnoid hemorrhage,incidence of cranial fracture,proportion of patient with positive Babinski sign,PT,TT,APTT,FIB,diastolic blood pressure,systolic blood pressure,operation time,platelet count and Glasgow Coma Scale(GCS)score(P<0.05).The results of multivariate Logistic regression analysis showed that onset-to-operation time〔OR=1.510,95%CI(1.261,1.808)〕,cranial fracture〔OR=1.379,95%CI(1.172,1.622)〕,positive Babinski sign〔OR=1.474,95%CI(1.263,1.721)〕,and TT〔OR=1.289,95%CI(1.005,1.654)〕were independent factors influencing delayed intracran
作者
王津津
陈春峰
尹志君
杨杰
WANG Jin-jin;CHEN Chun-feng;YIN Zhi-jun;YANG Jie(Department of Neurosurgery,Jiangsu Shengze Hospital Affiliated to Nanjing Medical University,Suzhou 215228,China;Nanjing Medical University,Nanjing 210000,China)
出处
《实用心脑肺血管病杂志》
2018年第9期25-28,共4页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
2014年国家自然科学基金资助项目(81471199)
关键词
颅脑损伤
迟发性颅内血肿
预后
影响因素分析
Craniocerebral trauma
Delayed intracranial hematoma
Prognosis
Root cause analysis
