预测双侧慢性硬膜下血肿单侧引流术后对侧血肿进展的评分系统构建及其效果的初步评估  

A prognostic scoring system for contralateral hematoma progression of bilateral chronic subdural hematomas after initial unilateral evacuation and preliminary assessment of its effectiveness

作　　者：沈军[1] 袁莉莉 邵雪非[1] 王其福 江晓春[1] Shen Jun;Yuan Lili;Shao Xuefei;Wang Qifu;Jiang Xiaochun(Department of Neurosurgery,Yijishan Hospital of Wannan Medical College,Wuhu 241001,China;Department of Neurology,Yijishan Hospital of Wannan Medical College,Wuhu 241001,China)

机构地区：[1]皖南医学院弋矶山医院神经外科,芜湖241001 [2]皖南医学院弋矶山医院神经内科,芜湖241001

出　　处：《中华神经医学杂志》2019年第12期1255-1261,共7页Chinese Journal of Neuromedicine

摘　　要：目的探讨双侧慢性硬膜下血肿(bCSDHs)单侧引流术后对侧血肿进展的危险因素,并建立预测血肿进展的评分系统。方法选择皖南医学院弋矶山医院神经外科自2012年10月至2019年3月应用单侧引流术治疗的bCSDHs患者61例,随访过程中依据CT检查判断患者是否出现对侧血肿进展。比较进展组和无进展组患者临床资料的差异,采用多因素Logistic回归分析筛选术后对侧血肿进展的独立危险因素及建立各危险因素预测对侧血肿进展的受试者工作特征曲线(ROC)。依据多因素Logistic回归分析和ROC曲线分析结果建立预测对侧血肿进展的评分系统。结果与无进展组比较,进展组患者手术对侧血肿分布为广泛型、血肿密度为均匀低密度者所占比例较高,手术对侧术前血肿量、术后血肿量较高,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示:手术对侧血肿的分布为广泛型(OR=16.726,95%CI:2.034~137.557,P=0.009)、手术对侧术后血肿量(OR=1.044,95%CI:1.012~1.078,P=0.007)是对侧血肿进展的独立危险因素。ROC曲线分析显示:手术对侧血肿的分布和术后血肿量预测对侧血肿进展的曲线下面积分别为0.682(97%CI:0.551~0.796)、0.737(97%CI:0.608~0.841)。将手术对侧血肿为局限型设为0分、广泛型设为1分,手术对侧术后血肿量大于40 cm3设为1分、小于或等于40 cm3设为0分后对所有患者进行评分,统计显示总评分为0、1和2分患者对侧血肿进展的发生率差异有统计学意义(P<0.05)。结论手术对侧血肿为广泛型、手术对侧术后血肿量是bCSDHs单侧引流术后对侧血肿进展的独立危险因素,基于这两个因素建立的评分系统简单实用,可作为临床参考。Objective To investigate the risk factors for contralateral hematoma progression of bilateral chronic subdural hematomas(bCSDHs)after initial unilateral evacuation,and finally develop a prognostic scoring system.Methods Sixty-one patients with bCSDHs underwent initial unilateral evacuation in our hospital from October 2012 to March 2019 were chosen in our study.During follow up,CT examination was used to determine whether the patients had developed contralateral hematoma.The clinical data of patients from the progressive group and non-progressive group were retrospectively analyzed and compared.Multivariate Logistic regression was used to analyze the independent risk factors for postoperative contralateral hematoma progression.Receiver operating characteristic(ROC)curve was established to predict the progression of contralateral hematoma for each risk factor.A prognostic grading system was developed on the basis of independent risk factors and cut-off value.All patients were scored according to the scoring system and the progression rate of different scores were re-analyzed.Results As compared with the non-progressive group,the progressive group had higher proportions of patients with extensive contralateral hematoma distribution or low density of contralateral hematoma,higher amount of preoperative contralateral hematoma and postoperative hematoma,with statistically significant differences(P<0.05).Multivariate Logistic regression analysis showed that extensive contralateral hematoma distribution(OR=16.726,95%CI:2.034-137.557,P=0.009),and hematoma volume after contralateral hematoma surgery(OR=1.044,95%CI:1.012-1.078,P=0.007)were independent risk factors for contralateral hematoma progression.ROC curve showed that areas under the curve for contralateral hematoma distribution and hematoma volume after contralateral hematoma surgery were 0.682 and 0.737,respectively.Limited type of contralateral hematoma was set as 0 score,and extensive type was set as one score;hematoma volume after contralateral hematoma surgery>

关 键 词：慢性硬膜下血肿 单侧引流术 血肿进展 评分系统 

分 类 号：R651[医药卫生—外科学]