重型颅脑损伤患者大骨瓣减压术后迟发性颅内血肿对预后的影响  

Influence of delayed traumatic intracranial hemorrhage followed by large decompressive craniectomy in prognosis of patients with severe traumatic brain injury

作　　者：张恒[1] 秦治刚[1] 梁华新[1] 房晓萱[1] 

机构地区：[1]吉林大学中日联谊医院神经外科,吉林长春130033

出　　处：《吉林大学学报（医学版）》2016年第2期362-365,共4页Journal of Jilin University：Medicine Edition

基　　金：吉林省科技厅科技发展计划项目资助课题(200705314)

摘　　要：目的:探讨重型颅脑损伤(sTBI)患者行单侧大骨瓣减压术(LDC)后迟发性颅内血肿(DTICH)发生的危险因素及其对预后的影响,为提高sTBI患者救治成功率提供依据。方法:回顾性分析130例行单侧LDC的sTBI患者的临床资料。依据术后是否发生DTICH分为DTICH组(n=42)和非DTICH组(n=88),对比分析DTICH发生的危险因素及其对预后的影响。结果:2组患者术前格拉斯哥昏迷评分(GCS)、外伤至手术时间、并发颅骨骨折、中线移位>1cm、基底池消失、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)与DTICH的发生有关联(P<0.05)。多因素Logistic回归分析,外伤至手术时间、并发颅骨骨折、基底池消失和FIB是DTICH发生的独立危险因素(P<0.05)。对比分析2组患者的3个月后格拉斯哥预后评分(GOS),DTICH组患者预后明显差于非DTICH组(P<0.01)。结论:对于外伤至手术时间较短、并发颅骨骨折、基底池消失、FIB下降的患者,应高度警惕DTICH的发生。DTICH影响患者预后,提前预防和早期诊断是改善患者预后的关键。Objective： To explore the risk factors of delayed traumatic intracranial hematoma （DTICH） followed by unilateral large decompressive craniectomy （LDC） and its influence in the prognosis of the severe traumatic brain injury （sTBI） patients, and to improve the successful rate of the rescue. Methods： The clinical data of 130 sTBI patients underwent unilateral LDC were retrospectively analyzed. The patients were divided into DTICH group （n= 42） and non-DTICH group （n=88） according to whether the DTICH occurred after operation. The risk factors of DTICH and its influence were contrastively analyzed. Results： The analysis results of the clinical data of patients in two groups showed that preoperative GCS, time from trauma to operation, skull fracture, midline shift 〉 1 cm, basal cistern disappear, activated partial prothrombin time （APTT）, fibrinogen （FIB）, and thrombin time （TT） were significantly correlated with the appearance of DTICH （P〈O. 05）. Multivariable Logistic regression analysis showed that the time from trauma to operation, skull fracture, basal cistern disappearing and FIB were the independent risk factors of DTICH （P〈0.05）. The analysis results of GOS 3 months after operation of the patients in two groups showed that the prognosis of the patients in DTICH group was significantly worse than that in non- DTICH group （P〈0.01）. Oonclusion： For those patients who accompanied with shorter time from trauma to operation, skull fracture, basal cistern disappearing and FIB decrease, attention. DTICH can affect the prognosis of patients; prevention and prognosis of patients the appearance of DTICH should be paid early diagnosis are crucial to improve the

关 键 词：重型颅脑损伤 大骨瓣减压术 迟发性颅内血肿 危险因素 预后 

分 类 号：R651.15[医药卫生—外科学]