创伤性急性硬膜下血肿术后的对侧硬膜外血肿的相关因素分析  

Correlation factor analysis of postoperative epidural hematoma in patients with traumatic acute subdural hematoma

作　　者：雷波[1] 张召[1] 张孝礼[1] 万晓强[1] 卫正洪[1] 

机构地区：[1]四川省乐山市人民医院神经外科,614400

出　　处：《临床合理用药杂志》2017年第8期11-12,19,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的探讨创伤性急性硬膜下血肿术后对侧硬膜外血肿的发生机制及相关因素。方法选取医院收治的创伤性急性硬膜下血肿减压术后对侧硬膜外血肿、再次行硬膜外血肿清除术的患者28例,分析出现硬膜外血肿的相关因素、发生机制及出院时格拉斯哥预后评分(GOS),并结合患者资料实施Logistic回归分析。结果 4例出现凝血功能障碍的情况(1例凝血酶原时间延长,2例血小板减少,1例肝功能ALT增加);2例出现伤口引流障碍。28例中11例(39.29%)因颅骨骨折,术后即刻行对侧硬膜外血肿探查、清除术,术中发现出血量均>40 ml;4例(14.29%)术后观察到凝血功能障碍,复查CT对侧硬膜外血肿>30 ml;术后定期复查CT,6例(21.43%)发现颅脑创伤性对侧硬膜外血肿,其出血量均>20 ml;5例(17.59%)因发现对侧瞳孔散大后行头颅CT,对侧硬膜外血肿>30ml,2例来源为脑膜中动脉,3例为板障出血;出院时行GOS评分:重残、植物状态生存及死亡12例(42.86%),轻度残疾者16例(57.14%)。多因素分析表明年龄、颅骨骨折、血小板是创伤性急性硬膜下血肿手术后发生对侧硬膜外血肿的危险因素。结论年龄、颅骨骨折、凝血功能障碍是去骨瓣减压术后出现对侧硬膜外血肿的独立危险因素。术前充分评估,做好再出血手术预备方案;术中、术后密切观察脑压;提早探查对侧硬膜外出血征象是硬膜下血肿减压后对侧硬膜外血肿的预防关键。Objective To explore the mechanism of contralateral epidural hematoma after traumatic acute subdural hematoma. Methods 28 cases of patients with traumatic acute subdural hematoma who underwent contralateral epidural hema- toma and were treated with removal of epidural hernatoma were retrospectively analyzed in our hospital. To analyze the related factors, the mechanism of Occurrence of epidural hematoma and the Glasgow outcome score （GOS） at the time of discharge, and Logistic regression analysis was performed according to the data of the patients. Results 4 patients had coagulopathy （ 1 patient had prolonged prothrombin time, 2 had thrombocytopenia, 1 had increased ALT）. And 2 patients had wound drainage problems. 11 cases （39.29%） of the 28 cases, of which intraoperative blood loss was found to be 〉 40 ml due to ＂skull fracture＂ ,exploration and removal of contralateral epidural hematoma immediately after operation. 4 cases （14.29%） had blood clotting after operation, CT was found in contralateral epidural hematoma 〉 30 ml. 6 cases （21.43%） found traumatic contra- lateral subdural hematoma of the brain,the amount of bleeding were 〉 20ml （ 1 case） ;5 cases （ 17.59% ） were found to have ＂eontralateral pupil dilation＂ after the head CT, eontralateral epidural hematoma 〉 30ml,2 cases because of middle meningeal artery bleeding, 3 cases of diploe bleeding;GOS score at discharge： 12 patients （42.86%） with severe disability, plant state survival and death. 16 patients with mild disability （57.14%）. Multivariate analysis showed that age, skull fracture and plate- let were the risk factors of contralateral epidural hematoma after traumatic acute subdural hematoma. Conclusion Age, skull fracture and coagulation dysfunction are independent risk factors for contralateral epidural hematoma after decompressive crani- ectomy. Preoperative full evaluation, re-bleeding surgery to do a good job of preparation ;intraoperative and postoperative close observation of cerebral pre

关 键 词：硬膜外血肿 减压手术 创伤性 硬膜下血肿 

分 类 号：R651.15[医药卫生—外科学]