颅脑创伤患者开颅术后颅内再出血的相关因素分析  

Clinical analysis of related factors of delayed intracranial hemorrhage after craniectomy

作　　者：刘企源[1] 许文辉[1] 

机构地区：[1]江苏大学附属宜兴医院神经外科,214200

出　　处：《中华神经外科杂志》2013年第2期134-137,共4页Chinese Journal of Neurosurgery

摘　　要：目的探讨颅脑创伤患者开颅术后再出血的相关因素和诊疗经验。方法2008年2月至2012年4月江苏大学附属宜兴医院手术治疗外伤性迟发颅内血肿227例，对其中103例进行了二次手术。对临床资料采用多因素Logistic回归分析判断本病的危险因素。结果按照GOS评分标准：恢复良好23例，中残21例，重残23例，植物生存12例，死亡24例。多因素Logistic回归分析表明多部位颅骨骨折、合并高血压、凝血功能异常和脑挫裂伤是颅脑外伤术后迟发血肿再次手术的主要危险因素（OR值为4．290、3．662、2．557、1．893）。迟发血肿主要出现在颞叶和额叶，出血来源：脑挫伤组织51．5％，骨缝31．1％，硬脑膜表面小动脉8．7％，静脉窦8．7％。结论对有危险因素的患者手术前后均应该预判断，根据生命体征、症状的变化，尽早手术干预，预防并发症是降低本病病死率和致残率的关键。Objective To study secondary surgery for DTICH after the evacuation of traumatic intracranial hematoma mainly about risk factors, predilection sites, prejudging, observations, and treatments. Methods There were 227 cases of DTICH from 2008 Feb. to 2012 Apr. which had 103 cases with secondary surgery. A retrospective and risk factors analysis was conducted with clinical materials using muhivariate logistic regression. Results In line with the GOS score ： there were 23 cases of good recovery, 21 cases of moderate disability, 23 cases of severe disability, 12 cases of vegetative state, and 24 cases of deaths. Multivariate Logistic regression showed that the major risk factors were multi - site skull fractures, patients with hypertension, abnormal coagulations and brain contusions （ OR = 4. 290,3. 662,2. 557, 1. 893 ）. Delayed hematoma mainly occurred in the temporal lobe and frontal hemorrhage, its sources were： contuse brain tissues 51.5%, bone sewings 31.1%, small arterieson dural surface 8.7%, and sinuses 8.7 %. Conclusion Pre -judgment for all patients with risk factors, attention to the mechanism of injury, changes in vital signs, surgical intervention as early as possible, and preventing complications were all keys to decreasing the mortality and disable rate.

关 键 词：外伤性脑损伤 手术后出血 迟发性颅内血肿 危险因素 

分 类 号：R651.15[医药卫生—外科学]