摘要
目的探讨老年中重型创伤性颅内血肿病人手术治疗的临床疗效及术后并发症。方法2021年1月~2023年11月我院收治60岁以上老年创伤性颅内血肿病人80例,均采用手术治疗,观察其临床疗效及术后并发症,根据格拉斯哥预后评分量表将其分为预后较好组和预后不良组,采用单因素分析及多因素Logistic回归分析不良预后的影响因素,同时与国际颅脑损伤预后临床测试研究(IMPACT)模型计算的预期预后相比较,评价手术的治疗效果。结果80例病人中,6个月后预后良好46例(57.5%),预后不良34例(42.5%),其中死亡13例(16.25%)。通过IMPACT模型计算预期预后不良率为63.8%,预期死亡率为46.6%,实际预后均较预期预后好。实际预后不良率和预期预后不良率以及实际死亡率与预期死亡率比较,差异有统计学意义(P<0.05)。单因素分析结果显示,病人瞳孔反应、术前格拉斯哥昏迷评分、血肿部位、环池状态、中线移位和血肿大小与病人预后相关。多因素Logistic回归分析结果显示,环池状态是老年中重型颅脑损伤不良预后的独立危险因素。结论对于有手术指征的老年创伤性颅内血肿的病人应该积极手术治疗,积极治疗效果良好,术后病人颅内高压未能纠正是死亡主要原因。
Objective To investigate the clinical efficacy and postoperative complications of surgical treatment for middle-aged and severe elderly patients with traumatic intracranial hematoma.Methods A retrospective analysis was conducted on the clinical data,efficacy,and postoperative complications of 80 elderly patients with traumatic intracranial hematoma who underwent surgical treatment at the Neurosurgery Department of Jianli People’s Hospital from January 2021 to November 2023.The Glasgow Outcome Scale was used to evaluate their clinical prognosis,and they were divided into a good prognosis group and a poor prognosis group based on their scores.Univariate analysis and multivariate logistic regression analysis were used to analyze the influencing factors related to poor prognosis,and compared with the expected prognosis calculated by the International Clinical Trial Study on Brain Injury Prognosis(IMPACT)model to evaluate the therapeutic effect of the surgery.Results Among 80 patients aged 60 and above who underwent surgery for moderate to severe traumatic intracranial hematoma,46(57.5%)had a good prognosis after 6 months of follow-up,34(42.5%)had a poor prognosis,and 13(16.25%)died.The expected poor prognosis rate was calculated to be 63.8%by using the IMPACT experimental core model,and the expected mortality rate was 46.6%.The actual prognosis was better than the expected one.The difference between the actual and expected prognosis and the actual and expected mortality was statistically significant(P<0.05).Univariate analysis suggests that patient’s pupil response,preoperative GCS score,hematoma location,cisternaambiens status,midline displacement,and hematoma size are correlated with patient prognosis.Multivariate analysis suggests that the status of the cisternaambiens is an independent risk factor for poor prognosis in elderly patients with moderate to severe traumatic brain injury.Conclusion Elderly patients with traumatic intracranial hematoma who have surgical indications should be treated with surgery,and
作者
杨辉
万学焱
YANG Hui;WAN Xueyan(Department of Neurosurgery,Jianli People’s Hospital,China Three Gorges University,Jianli,Huebei 433300,China;不详)
出处
《临床外科杂志》
2024年第7期697-700,共4页
Journal of Clinical Surgery
基金
湖北省自然科学基金面上项目(2021CFB394)
华中科技大学同济医学院附属同济医院留学归国人员启动基金(2020HGRY009)。
关键词
老年
创伤性颅内血肿
手术
elderly
traumatic intracranial hematoma
surgery
