75岁以上老年人急性硬膜下血肿近期预后相关因素的分析  

Analysis of the factors related to short-term prognosis in the patients older than 75 years with acute subdural hematoma

作　　者：林维斌 赵静[2] 徐朝阳[1] Lin Wei-bin;Zhao Jing;Xu Chao-yang(Department of Neurosurgery,the Second Affiliated Hospital,Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院神经外科,福建泉州362000 [2]福建医科大学附属第二医院门诊手术室

出　　处：《中国急救医学》2020年第2期113-116,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨75岁以上急性硬膜下血肿(ASDH)患者近期预后的影响因素.方法回顾性分析2013年1月至2017年12月福建医科大学附属第二医院神经外科106例75岁以上ASDH患者的临床资料及预后情况,对入院格拉斯哥昏迷评分(GCS)、合并脑挫裂伤、血肿侧别、血肿厚度、中线偏移、脑疝、环池状态等指标行单因素分析,对有意义的指标再行Logistic多因素分析.结果入院GCS评分低于8分患者预后不良率为87.1%,合并脑疝的患者预后不良率为95.0%.单因素分析显示,血肿厚度与预后无明显相关性(P>0.05).入院GCS评分、合并脑挫裂伤、血肿侧别、血肿厚度、中线偏移、脑疝、环池状态与近期预后发生具有相关性(P<0.05).Logistic多因素分析显示,入院GCS评分、环池状态对近期预后的影响有明显统计学意义(P<0.05),两者Wald值分别为6.518、11.616,表明两者对近期预后影响最大.结论75岁以上AS-DH患者近期预后为多因素影响的结果.入院GCS评分和环池状态对近期预后影响最大,入院GCS评分≤8分、环池闭塞是预后不良的重要预测因素.Objective To explore the short-term prognostic factors affecting acute subdural hematoma(ASDH)in the patients older than 75 years.Methods The clinical data of 106 patients older than 75 years with ASDH admitted to our hospital from January 2013 to December 2017 retrospectively.Univariate analysis was carried out on related factors including Glasgow coma scale(GCS)score on admission,combined brain contusion,hematoma sid e,hematoma thickness,midline shift,cerebral herniation and the status of ambient cisterns,and Logistic multivariate regression analysis was made on significant indexes.Results Patients with GCS score less than 8 had a poor prognosis rate of 87.1%,that of the patients with cerebral herniation reached 95.0%.There was no significant correlation between hematoma thickness and prognosis(P>0.05).Univariate analysis showed related factors including GCS on admission,brain contusion,hematoma side,hematoma thickness midline shift,cerebral herniation and the status of ambient cisterns were significantly correlated with short-term prognosis of ASDH in the patients older than 75 years(P<0.05).Multivariate analysis showed that the impact of the admission GCS and the status of ambient cisterns on the short-term prognosis were statistically significant(P<0.05).Wald values of them were 6.518 and 11.616,respectively,indicating that they were the main influence factors on the short-term prognosis.Conclusion The prognosis of ASDH in the patients over 75 years old is influenced by many factors.GCS score on admission and the status of ambient cisterns were the main influence factors on short-term prognosis.GCS score≤8 and ambient cisterns efacement were significant prognostic predictors for unfavorable outcome in the patients with ASDH.

关 键 词：颅脑损伤 急性硬膜下血肿(ASDH) 老年人 格拉斯哥昏迷(GCS)评分 预后 

分 类 号：R651.15[医药卫生—外科学]