慢性硬膜下血肿钻孔引流术后减压性出血的危险因素及其预测作用  

Risk factors for decompressive bleeding after drilling and drainage of chronic subdural hematoma and their predictive role

作　　者：费振海 蔡勇[1] 钟兴明[1] 汪一棋[1] 阳建国[1] 赵朝辉[1] 张磊[1] 顾华[1] 杨涛[1] Fei Zhenhai;Cai Yong;Zhong Xingming;Wang Yiqi;Yang Jianguo;Zhao Zhaohui;Zhang Lei;Gu Hua;Yang Tao(Department of Neurosurgery,the First People′s Hospital of Huzhou(the First Affiliated Hospital of Huzhou University),Huzhou 313000,China)

机构地区：[1]湖州市第一人民医院(湖州师范学院附属第一医院)神经外科,湖州313000

出　　处：《中华神经外科杂志》2023年第2期167-171,共5页Chinese Journal of Neurosurgery

基　　金：浙江省基础公益研究计划(LGF21H090001)。

摘　　要：目的探讨慢性硬膜下血肿(CSDH)患者钻孔引流术后发生减压性出血的危险因素及其对减压性出血的预测作用。方法回顾性分析2018年1月至2022年1月湖州市第一人民医院神经外科收治的150例行钻孔引流术的CSDH患者的临床资料。分析年龄、性别、头部外伤史、是否合并糖尿病、术前格拉斯哥昏迷评分(GCS)、平均动脉压、血肿腔内压力、血肿密度、血肿量、最大血肿厚度、术前服用抗凝和抗血小板药物情况、神经功能缺损情况、术中置管长度、术后中线回复速率、术后残留大量积气对术后减压性出血的影响,将差异有统计学意义的因素纳入多因素logistic回归模型,分析影响术后减压性出血的危险因素。绘制受试者工作特征(ROC)曲线,评估相关危险因素对减压性出血的预测效能。结果150例患者中共27例(18.0%)发生术后减压性出血。与无减压性出血组比较,减压性出血组患者的血肿腔内压力高、术前平均动脉压高、血肿密度为混杂密度及血肿量≥100 ml的患者占比高、术后中线回复速率快,差异均有统计学意义(均P<0.05),其他因素差异均无统计学意义(均P>0.05)。多因素logistic回归分析显示,血肿腔内压力高(OR=1.04,95%CI:1.01~1.08,P=0.021)和术后中线回复速率快(OR=4.17,95%CI:1.28~13.58,P=0.018)是CSDH患者钻孔引流术后发生减压性出血的危险因素(均P<0.05)。ROC曲线分析显示,血肿腔内压力预测术后减压性出血的曲线下面积(AUC)为0.99,截断值为306 mm H_(2)O(1 mm H_(2)O=0.0098 kPa);术后中线回复速率预测减压性出血的AUC为0.98,截断值为4.08 mm/d。结论血肿腔内压力高及术后中线回复速率过快的CSDH患者钻孔引流术后发生减压性出血的风险高,这些危险因素对减压性出血有预测作用。Objective To investigate the risk factors of decompressive bleeding after drilling and drainage in patients with chronic subdural hematoma(CSDH)and their predictive role.Methods The clinical data of 150 CSDH patients admitted to the Department of Neurosurgery,the First People′s Hospital of Huzhou from January 2018 to January 2022 were retrospectively analyzed.The effects of age,gender,history of head trauma,whether the patient had diabetes,preoperative Glasgow coma score(GCS),mean arterial pressure,intracavitary pressure of hematoma,midline recovery rate,hematoma density,hematoma volume,maximum hematoma thickness,preoperative use of anticoagulant and antiplatelet drugs,neurological deficit,length of intraoperative catheterization,and residual massive gas accumulation on postoperative decompressive bleeding were analyzed.The factors with statistical significance were included in the multivariate logistic regression model to analyze the risk factors of postoperative decompressive bleeding.The ROC(receiver operating characteristic)curve was drawn to evaluate the predictive efficacy of related risk factors on decompressive hemorrhage.Results A total of 27(18.0%)of the 150 patients had postoperative decompressive hemorrhage.Compared with those without decompressive hemorrhage,the patients with decompressive hemorrhage had higher intracavitary pressure of hematoma,faster midline recovery rate,higher preoperative mean arterial pressure,mixed density of hematoma and higher proportion of hematoma volume≥100 ml,with statistically significant differences(all P<0.05),while other factors had no significant differences(all P>0.05).Multivariate logistic regression showed that high intracavitary pressure of hematoma(OR=1.04,95%CI:1.01-1.08,P=0.021)and fast midline recovery rate(OR=4.17,95%CI:1.28-13.58,P=0.018)were the risk factors for decompressive hemorrhage in the CSDH patients after drilling and drainage(all P<0.05).ROC analysis showed that the area under the curve(AUC)of hematoma cavity pressure predicting postoperative

关 键 词：血肿 硬膜下 慢性 引流术 钻孔 减压性出血 危险因素 预测 

分 类 号：R651.15[医药卫生—外科学]