颅脑损伤患者开颅术后血肿的原因分析  

Analysis of causes of hematomas after craniotomy in patients with craniocerebral injury

作　　者：张洪清 周雄鄂 何庆 

机构地区：[1]襄樊市中医院神经外科,湖北441000

出　　处：《中国临床神经外科杂志》2010年第12期729-731,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的分析颅脑损伤患者开颅术后发生术后血肿的主要原因。方法回顾性分析863例颅脑损伤患者开颅术后发生术后血肿的38例患者的临床资料。结果脑挫裂伤伴颅内血肿的患者和凝血功能障碍的颅脑损伤患者术后颅内血肿的发生率分别明显高于硬膜外(或硬膜下)血肿的患者和凝血功能正常的颅脑损伤患者。血压高于160/110mmHg的颅脑损伤患者术后颅内血肿的发生率明显高于血压为140-160/90-110mmHg者(P<0.05),而后者术后颅内血肿的发生率又明显高于血压低于140/90mmHg者(P<0.01)。不同性别、年龄和入院时GCS评分的颅脑损伤患者术后颅内血肿的发生率无明显差异(P>0.05)。结论脑挫裂伤并脑内血肿、高血压、凝血机制异常、止血不彻底等是导致颅脑损伤患者开颅术后血肿的主要原因,完全可靠的止血技术、细致耐心的手术操作及周密的防范措施是预防其开颅术后血肿的关键。Objective To analyze the main causes of postoperative hematomas （POH） in the patients with craniocerebral injury. Method The clinical data of 38 patients with POH of the 863 patients with craniocerebral injury who underwent craniotomy were analyzed retrospectively. Results The incidence of POH in the patients with cerebral contusion accompanied with intracerebral hematomas was significantly higher than that in the patients with epidural hematomas or subdural hematomas （P〈0.01）. The incidence of POH in the patients with blood pressure of more than 160/110 mmHg was significantly higher than that in the patients with blood pressure of 140-160/90-110 mmHg （P〈0.05） in whom the incidence of POH was significantly higher than that in the patients with blood pressure of lower than 140/90 mmHg （P〈0.01）. The incidence of POH in the patients with coagulation function disturbance was significantly higher than that in the patients with normal coagulation function （P〈0.01）. There was insignificant difference in the incidence of POH between male and female patients or among the different age patients or the patients with different GCS （P〉0.05）. Conclusions The main causes of POH include cerebral contusion accompanied with intracrerbral hematomas, hypertension and coagulation function disturbance. And incomplete hemostasis during the surgery is also important cause of POH.

关 键 词：颅脑损伤 开颅 术后血肿 原因 

分 类 号：R651.15[医药卫生—外科学]