急性外伤性硬膜下血肿手术预后因素分析  

Analysis of prognostic factors for patients with traumatic acute subdural hematomas treated by surgery

作　　者：宋超强[1] 任晓辉[2] 赵宝刚[1] 付辉[1] 林松[2] 张岩[2] 

机构地区：[1]北京市大兴区人民医院神经外科 ,102600 [2] 首都医科大学附属北京天坛医院神经外科

出　　处：《中华医学杂志》2014年第17期1349-1352,共4页National Medical Journal of China

摘　　要：目的 分析急性外伤性硬膜下血肿手术治疗预后的相关因素.方法 回顾性分析北京市大兴区人民医院神经外科2007年1月至2012年7月病例资料完整的手术治疗的117例急性硬膜下血肿患者临床资料,应用统计学分析患者预后相关因素.预后评估采用GOS评分,4～5分者为恢复良好.结果 术后恢复良好51例（43.59％）,死亡46例（39.32％）.急性硬膜下血肿恢复良好的相关因素包括：年龄＜40岁、术前GCS评分＞8分、术前无脑疝、从外伤到手术有效减压时间≤4h;无引流静脉损伤;术毕脑肿胀程度轻及脑搏动良好.急性硬膜下血肿患者死亡相关因素包括：年龄＞ 60岁、术前GCS评分≤8分、术前脑疝、从外伤到手术有效减压时间＞4h;引流静脉损伤;术毕脑肿胀明显及脑搏动微弱.经过Logistic回归分析术前GCS评分、术前有无脑疝、术后脑搏动恢复情况是影响患者预后的独立相关因素.结论 急性硬膜下血肿患者年龄＜ 40岁、术前GCS评分＞8分、术前无脑疝、术毕脑搏动良好者预后相对好.Objective To analyze the factors correlated with the surgical prognosis of patients with traumatic acute subdural hematoma （ASDH）.Methods A total of 117 surgical patients for traumatic ASDH between January 2007 and August 2012 were retrospectively reviewed.The clinical factors correlated with prognosis were statistically analyzed.Glasgow outcome score （GOS） was used for prognostic evaluations and favorable prognosis was defined as 4-5 points.Results The percentage of patients with favorable prognosis was 43.59% and the mortality 39.32%.The factors correlated with favorable prognosis included age 〈 40 years,pre-operative GCS 〉 8,no pre-operative herniation,duration between injury and surgical depression ≤4 h,without injury of drainage vein,mild brain edema and good brain palpation; the factors correlated with mortality included age 〉 60 years,pre-operative GCS ≤8,pre-operative herniation,duration between injury and surgical depression 〉 4 h,injury of drainage vein,serious brain edema and weak brain palpation Logistic regression confirmed preoperative GCS 〉 8,no preoperative herniation,injury of drainage vein and postoperative good brain palpation were independent factors associated with favorable prognosis.Conclusion Patients with age 〈 40 years,preoperative GCS 〉 8,no preoperative herniation,injury of drainage vein and postoperative good brain palpation tend to have favorable prognoses.

关 键 词：急性 硬膜下血肿 预后 

分 类 号：R651.1[医药卫生—外科学]