颅脑损伤患者行急诊颅内血肿清除术后迟发性颅内血肿的影响因素分析  

Analysis of factors affecting delayed intracranial hematoma after emergency evacuation of intracranial hematoma in patients with craniocerebral injury

作　　者：李文生 LI Wen-sheng(Heyuan People’s Hospital,Heyuan 517000,China)

机构地区：[1]河源市人民医院,517000

出　　处：《中国实用医药》2021年第26期1-4,共4页China Practical Medicine

摘　　要：目的探究颅脑损伤患者行急诊颅内血肿清除术后迟发性颅内血肿的影响因素。方法40例颅脑损伤患者,均接受开颅清除血肿术,以发生迟发性颅内血肿患者为研究组,以未发生迟发性颅内血肿患者为对照组,每组20例。整理患者临床资料,包括患者的受伤机制(加速性,减速性);首次行CT检查时间;患者的颅脑损伤程度;颅脑损伤情况(开放性损伤、颅骨骨折、脑挫裂伤);血肿量;血肿位置(硬膜上、硬膜下、脑内);血糖;血压(收缩压、舒张压);凝血指标[血小板计数(PLT)、凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)];入院至手术的时间;去骨瓣减压术与否。分析颅脑损伤患者术后发生迟发性颅内血肿的影响因素。结果经单因素分析显示,研究组患者颅脑损伤程度较对照组严重,颅骨骨折占比80.0%、脑挫裂伤占比65.0%、硬膜上血肿发生率80.0%、血糖(12.51±4.04)mmol/L、舒张压(87±21)mm Hg(1 mm Hg=0.133 kPa)、TT(18.78±2.81)s、PT(10.15±1.01)s、APTT(34.27±10.44)s、入院至手术的时间(6.62±2.81)h与对照组的50.0%、30.0%、35.0%、(9.06±3.31)mmol/L、(71±13)mm Hg、(13.26±2.09)s、(9.18±0.93)s、(26.42±9.93)s、(17.24±6.78)h比较,差异均具有统计学意义(P<0.05)。Logistic回归分析显示,重度颅脑损伤、颅骨骨折、脑挫裂伤及TT是颅脑损伤患者术后发生迟发性颅内血肿的独立危险因素(P<0.05)。结论颅脑损伤患者术后发生迟发性颅内血肿与其损伤类型、损伤程度、血肿位置、血糖、血压、凝血指标、入院至手术时间等多个因素相关,而重度颅脑损伤、颅骨骨折、脑挫裂伤以及TT是颅脑损伤患者术后发生迟发性颅内血肿的独立危险因素。Objective To investigate the factors affecting delayed intracranial hematoma after emergency evacuation of intracranial hematoma in patients with craniocerebral injury.Methods There were 40 patients with craniocerebral injury,and all patients underwent evacuation of intracranial hematoma.Patients with delayed intracranial hematoma were taken as the research group,and patients without delayed intracranial hematoma were taken as the control group,with 20 cases in each group.Collation of the patient’s clinical data,including their mechanism of injury(accelerated,decelerated);time of the first CT examination;degree of cranial injury;cranial injury(open injury,skull fracture,cerebral contusion);hematoma volume;location of the hematoma(supradural,subdural,intracerebral);blood glucose;blood pressure(systolic blood pressure,diastolic blood pressure);coagulation indexes[platelet count(PLT),thrombin time(TT),prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB)];duration from admission to surgery;decompressive craniectomy or not.The influencing factors of postoperative delayed intracranial hematoma in patients with craniocerebral injury were analyzed.Results Univariate analysis showed that patients in the research group had a more severe degree of craniocerebral injury than the control group,with 80.0%of skull fractures,65.0%of cerebral contusions,80.0%of supradural hematomas,blood glucose(12.51±4.04)mmol/L,diastolic blood pressure(87±21)mm Hg(1 mm Hg=0.133 kPa),TT(18.78±2.81)s,PT(10.15±1.01)s,APTT(34.27±10.44)s,and duration from admission to surgery(6.62±2.81)h,which were statistically significant compared with 50.0%,30.0%,35.0%,(9.06±3.31)mmol/L,(71±13)mm Hg,(13.26±2.09)s,(9.18±0.93)s,(26.42±9.93)s,and(17.24±6.78)h in the control group(P<0.05).Logistic regression analysis showed that severe craniocerebral injury,skull fracture,cerebral contusion and TT were independent risk factors for the development of postoperative delayed intracranial hematoma in patients with craniocerebral i

关 键 词：颅脑损伤 急诊 颅内血肿清除术 迟发性颅内血肿 影响因素 

分 类 号：R651.15[医药卫生—外科学]