抗血栓治疗患者创伤性颅内血肿急诊围手术期管理策略  

Perioperative management strategies of emergency surgery for patients with traumatic intracranial hematoma receiving antithrombotic therapy

作　　者：曾维培 郭子泉 陈太董 吴杰[1] ZENG Weipei;GUO Ziquan;CHENG Taidong;WU Jie(Department of Neurosurgery,People's Hospital of Qionghai,Qionghai 571400,China)

机构地区：[1]海南省琼海市人民医院神经外科,海南琼海571400

出　　处：《包头医学院学报》2021年第8期43-47,共5页Journal of Baotou Medical College

摘　　要：目的:研究伤前服用抗栓药物的创伤性颅内血肿患者急诊围手术期治疗措施,探讨此类患者围手术期管理策略。方法:通过对临床资料的回顾性分析,将30例接受急诊手术抗血栓治疗的创伤性颅内血肿患者纳入观察组;随机选取30例未进行抗血栓治疗的颅内血肿患者为对照组;对比两组患者的凝血功能、手术耗时、术中失血量、血制品用量及术后再出血率;通过格拉斯哥预后评分(GOS)评价预后。结果:观察组患者的血液呈低凝状态,经过积极治疗,凝血功能得到改善;观察组患者的手术耗时、术中失血量、血制品用量高于对照组(P<0.05);观察组患者术后再出血发生率为40.0%,高于对照组的10.0%(P<0.05);观察组患者的死亡率为33.3%,高于对照组的16.7%(P<0.05);不利结局者比率63.3%,高于对照组的43.3%,而有利结局者比率36.7%低于对照组的56.7%(P<0.05)。结论:受伤前的抗栓治疗会增加脑部围手术期出血风险,多学科会诊制定个体化管理策略,有助于保证患者围手术期安全,提高手术成功率,改善病人预后。Objective:To study the perioperative treatment of emergency surgery for the treatment of patients with traumatic intracranial hematoma with antithrombotic drugs before injury and explore the perioperative management strategies for such patients.Methods:Through retrospective analysis of clinical data,30 patients with traumatic intracranial hematoma who received emergency surgical antithrombotic treatment were included in the observation group.30 patients with intracranial hematoma without antithrombotic therapy were randomly selected as the control group.The coagulation function,operation time,intraoperative blood loss,dosage of blood products and postoperative rebleeding rate were compared between the two groups.The prognosis was evaluated by the Glasgow Outcome Score(GOS).Results:The blood of the observation group was in a state of low coagulation,and the coagulation function was improved after active treatment.The operation time,intraoperative blood loss and dosage of blood products in observation group were higher than those in control group(P<0.05).The incidence of postoperative rebleeding in the observation group was 40.0%,which was higher than that in the control group(10.0%,P<0.05).The mortality rate of observation group was 33.3%,which was higher than that of control group(16.7%)(P<0.05).The ratio of adverse outcome(63.3%)was higher than that of control group(43.3%),while the ratio of favorable outcome(36.7%)was lower than that of control group(56.7%)(P<0.05).Conclusion:Antithrombotic therapy before injury increases the risk of perioperative bleeding in the brain.The individualized management strategies formulated through multidisciplinary consultations will contribute to perioperative safety,increase the success rate of surgery and improve the prognosis of patients.

关 键 词：创伤性颅内血肿 急诊手术 围手术期 抗血栓治疗 管理策略 

分 类 号：R47[医药卫生—护理学]