重型颅脑损伤患者去大骨瓣减压术后迟发性颅内血肿的影响因素分析  

Influencing factors of delayed traumatic intracranial hematoma after decompressive craniectomy in patients with severe craniocerebral injury

作　　者：蔺灿灿 潘亚茹 黄露露 Lin Cancan;Pan Yaru;Huang Lulu(Department of Neurology Surgery I,the First People’s Hospital of Shangqiu,Shangqiu 476000,China)

机构地区：[1]商丘市第一人民医院神经外一科,商丘476000

出　　处：《中国实用医刊》2022年第24期53-56,共4页Chinese Journal of Practical Medicine

摘　　要：目的分析重型颅脑损伤患者去大骨瓣减压术后迟发性颅内血肿(DTIH)的影响因素。方法抽取2019年4月至2021年12月商丘市第一人民医院收治的重型颅脑损伤患者82例,均采用去大骨瓣减压术治疗,将术后发生DTIH的31例患者纳入术后发生DTIH组,术后未发生DTIH的51例患者纳入术后未发生DTIH组,调查两组患者的一般资料及临床资料,分析术后并发DTIH的影响因素。结果术后发生DTIH组患者合并脑挫裂伤、合并颅骨骨折、术前瞳孔发生改变、格拉斯哥昏迷量表≤5分、术前Rotterdam CT评分≥3分者占比高于术后未发生DTIH组,纤维蛋白原(FIB)含量低于术后未发生DTIH组,凝血酶原时间(PT)、凝血酶时间(TT)及活化部分凝血活酶时间(APTT)均长于术后未发生DTIH组,创伤至接受手术时间短于术后未发生DTIH组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,合并颅骨骨折、术前瞳孔发生改变、格拉斯哥昏迷量表评分≤5分及以下、术前Rotterdam CT评分≥3分、FIB及PT异常、创伤至接受手术时间过短均是重型颅脑损伤患者行去大骨瓣减压术后并发DTIH的影响因素(P均<0.05)。结论重型颅脑损伤患者合并颅骨骨折、术前瞳孔发生改变、格拉斯哥昏迷量表评分≤5分、术前Rotterdam CT评分≥3分、凝血功能异常、创伤至接受手术时间过短时,并发DTIH的风险更高。Objective To analyze the influencing factors of delayed traumatic intracranial hematoma(DTIH)after decompressive craniectomy in patients with severe craniocerebral injury.Methods A total of 82 patients with severe craniocerebral injury treated in the First People’s Hospital of Shangqiu from April 2019 to December 2021 were selected.All of them were treated by decompressive craniectomy.Thirty-one patients with postoperative DTIH after surgery were included in the postoperative DTIH group,and 51 patients without postoperative DTIH after surgery were included in the postoperative non-DTIH group.The general information and clinical data of the two groups were investigated to analyze the influencing factors of postoperative DTIH after operation.Results The proportion of patients complicated by brain contusion and laceration,with skull fractures,with preoperative pupil change,with Glasgow coma scale score of 5 or less,and with preoperative Rotterdam CT score of 3 or more in the postoperative DTIH group were higher than those in the postoperative non-DTIH group,and the fibrinogen(FIB)content of the postoperative DTIH group was lower than that of the postoperative non-DTIH group(P<0.05).After treatment,the prothrombin time(PT),thrombin time(TT)and activated partial thromboplastin time(APTT)of the postoperative DTIH group were longer than those of postoperative non-DTIH group,moreover,the time from trauma to operation was shorter than that of the postoperative non-DTIH group(P<0.05).Results of Logistic regression analysis showed that skull fractures,preoperative pupil change,Glasgow coma scale score of 5 or less,Rotterdam CT score of 3 or more before operation,abnormal level of FIB and PT,and short time from trauma to operation were all the influencing factors of DTIH in patients with severe brain injury after decompressive craniectomy(all P<0.05).Conclusions Patients with severe craniocerebral injury complicated by skull fractures,preoperative pupil changes,Glasgow coma scale score of 5 or less,preoperative Rotterdam C

关 键 词：颅脑损伤 去大骨瓣减压术 迟发性颅内血肿 影响因素 

分 类 号：R651.15[医药卫生—外科学]