危重型颅脑损伤术后伴发对侧迟发性颅内血肿的危险因素研究  

Risk factors of postoperative contralateral delayed intracranial hematoma in patients with severe craniocerebral injury

作　　者：刘昊 鲁刚 李浩 LIU Hao;LU Gang;LI Hao(Department of Neurosurgery,Xinyang Central Hospital,Xinyang,Henan 464000,China)

机构地区：[1]信阳市中心医院神经外科,河南信阳464000

出　　处：《医药论坛杂志》2024年第6期641-644,648,共5页Journal of Medical Forum

摘　　要：目的探讨危重型颅脑损伤(severe traumatic brain injury,STBI)患者术后伴发对侧迟发性颅内血肿(delayed traumatic intracranial hematoma,DTICH)的危险因素。方法纳入2021年2月至2023年2月信阳市中心医院收治行大骨瓣开颅手术的50例STBI患者进行研究,按术后对侧DTICH发生与否分为DTICH组及非DTICH,收集两组人口学信息、临床资料、实验室指标及影像学表现等数据并作比较,行单因素及logistic回归模型多因素分析术后伴发对侧DTICH独立性风险因素。结果两组性别、年龄、婚姻状况、创伤类型、高血压史、术前瞳孔改变、血小板计数(WBC)、凝血酶原时间(PT)、部分凝血活酶时间(APTT)、凝血酶时间(TT)比较差异无统计学意义(P>0.05);两组创伤至手术时间、纤维蛋白原(Fib)、Rotterdam CT、合并颅骨骨折及术前病灶类型比较,差异有统计学意义(P<0.05);经logistic回归模型多因素分析显示术后伴发对侧DTICH独立性风险因素为创伤至手术时间(OR:2.633;95%CI:1.277~10.053)、Rotterdam CT评分(OR:2.206;95%CI:1.606~3.030)、合并颅骨骨折(OR:1.902;95%CI:1.032~3.506)及术前病灶类型(OR:2.759;95%CI:1.034~7.367)。结论影响STBI患者应用大骨瓣开颅手术后伴发对侧DTICH的危险因素包括创伤至手术时间长、Rotterdam CT评分高,合并颅骨骨折及脑挫裂伤,临床上需针对上述高危人群应进行早期干预,可一定程度降低对侧DTICH发生风险。Objective To investigate the risk factors of postoperative contralateral delayed intracranial hematoma(DTICH)in patients with severe traumatic brain injury(STBI).Methods Totally 50 patients wish STBI admitted from February 2021 to February 2023 who underwent large craniotomy were included in the study.According to the occurrence of contralar DTICH,they were divided into DTICH group and non-DTICH group.Demographic information,clinical data,laboratory indicators and imaging findings of the two groups were collected and compared.Univariate and logistic regression models were used to analyze the independent risk factors of postoperative contralateral DTICH.Results There were no significant differences in gender,age,marital status,trauma type,history of hypertension,preoperative pupil change,WBC,PT,APTT and TT between the two groups(P>0.05).There were statistically significant differences in the time from trauma to surgery,Fib,Rotterdam CT,combined skull fracture and preoperative lesion type between the two groups(P<0.05).Multivariate logistic regression analysis showed that postoperative contralateral DTICH independence risk factors were time from trauma to operation(OR:2.633;95%CI:1.277-10.053),Rotterdam CT score(OR:2.206;95%CI:1.606-3.030),combined with skull fracture(OR:1.902;95%CI:1.032-3.506)and preoperative lesion type(OR:2.759;95%CI:1.034-7.367).Conclusion The risk factors that affect STBI patients with contralateral DTICH after craniotomy with large bone flap include long time from trauma to operation,high Rotterdam CT score,skull fracture and brain contusion and laceration.Early intervention should be carried out for these high-risk groups in clinic,which can reduce the risk of contralateral DTICH.

关 键 词：危重型颅脑损伤 迟发性颅内血肿 大骨瓣减压术 危险因素 

分 类 号：R651.1[医药卫生—外科学]