外伤性进展性硬脑膜外血肿形成的相关因素  

Analysis of related factors of traumatic progressive epidural hematoma

作　　者：柏鲁宁[1] 柯尊华[1] 范小璇[1] 方永军[1] 畅涛[1] 周振国[1] 周峰[1] 周雄波[1] 侯文[1] 罗卫[1] 张毅[1] 赵晓平[1] 

机构地区：[1]陕西中医学院附属医院脑外科,陕西咸阳712000

出　　处：《上海医学》2013年第12期1028-1030,共3页Shanghai Medical Journal

基　　金：陕西省科学技术研究发展项目资助(2011K12-74)

摘　　要：目的分析外伤性进展性硬脑膜外血肿(PEDH)形成的相关因素。方法回顾分析陕西中医学院附属医院脑外科同期住院治疗的87例PEDH患者(PEDH组)和178例非PEDH患者(对照组)的临床资料和预后情况,比较两组患者的年龄、性别构成、首次CT检查的血肿量、颅骨骨折发生率、入院时格拉斯哥昏迷评分(GCS评分)、入院后GCS评分下降值、入院时脱水剂应用情况和凝血功能障碍发生率。采用Logistic回归分析PEDH发生的相关因素。结果两组间首次CT检查血肿量、颅骨骨折发生率、入院时GCS评分、入院后GCS评分下降值和凝血功能障碍发生率的差异均有统计学意义(P值均<0.05)。PEDH组术后患者恢复良好率为50.6%(44/87),显著低于对照组的60.7%(108/178,P<0.05);PEDH组术后患者重残率为23.0%(20/87),显著高于对照组的10.1%(18/178,P<0.05)。两组间病死率的差异无统计学意义(P>0.05)。Logistic回归分析显示,首次CT检查血肿量(OR=0.167,95%CI为0.040～0.706)、颅骨骨折(OR=4.701,95%CI为1.441～15.336)、入院时GCS评分(OR=0.530,95%CI为0.302～0.930)、入院后GCS评分下降值(OR=3.538,95%CI为1.084～11.183)、凝血功能障碍(OR=1.476,95%CI为1.044～3.183)为PEDH发生的危险因素(P值均<0.05)。结论首次CT检查血肿量、颅骨骨折、入院时GCS评分、入院后GCS评分下降、凝血功能障碍是PEDH发生的危险因素,PEDH可影响患者的预后。Objective To analyze the related factors of traumatic progressive epidural hematoma （PEDH）. Methods A retrospective study was conducted in 87 PEDH patients （PEDH group） and 178 patients without PEDH （control group） admitted to our hospital during the same period of treatment. Age, gender, hematoma in first CT scanning, skull fracture, Glasgow coma scale （GCS） score on admission and after admission, dehydrating agent on admission, and coagulation function were compared between two groups. PEDH related factors were detected by logistic regression analysis. Results There were significant differences in hematoma volume in first OT scanning, incidence of skull fracture and coagulation disorders, GCS score on admission and declining GCS score after admission between two groups （all P〈0.05）. Good recovery rate of PEDH group （50.6%, 44/87） was significantly lower than that of control group （60. 7%, 108/178, P〈0. 05）. Severe disability rate of PEDH group （23.0%, 20/87） was significantly higher than that of control group （10. 1%, 18/ 178, P〈 O. 05）. There was no significant difference in mortality between two groups （P 〉 0.05）. Logistic regression analysis found that hematoma volume in first CT scanning （ OR = 0. 167, 95% CI ：0. 040 - 0. 706）, skull fracture （OR = 4.701, 95 % CI ： 1.441 - 15. 336）, GCS score on admission （ OR = 0. 530, 95 % CI ： 0. 302 - 0. 930）, decrease of GCS score after admission （ OR = 3. 538, 95 % CI ： 1. 084 - 11. 183）, and coagulation disorder （OR = 1. 476, 95% CI ： 1. 044- 3. 183） were risk factors of PEDH （all P〈O. 05）. Conclusion Hematoma volume in first CT scanning, skull fracture, GCS score on admission, decrease of GCS score after admission, and coagulation disorder are risk factors of PEDH, which can affect Datient Droanosis.

关 键 词：进展性硬脑膜外血肿 相关因素 回顾性分析 

分 类 号：R651.15[医药卫生—外科学]