骑跨横窦硬膜外血肿的临床特征手术方式及预后分析  

Analysis of clinical features,operative treatment and prognosis of epidural hematoma of transverse sinus

作　　者：江南凯 黄常坚 李荣卓 张焕威 欧嘉华 JIANG Nankai;HUANG Changjian;LI Rongzhuo;ZHANG Huanwei;OU Jiahua(The People’s Hospital of Wuzhou,Wuzhou 543000,China)

机构地区：[1]梧州市人民医院,广西梧州543000

出　　处：《中国实用神经疾病杂志》2024年第9期1141-1145,共5页Chinese Journal of Practical Nervous Diseases

基　　金：广西壮族自治区卫生厅自筹经费科研课题(编号:Z2012704)。

摘　　要：目的分析骑跨横窦硬膜外血肿患者临床特征、手术方式及预后情况。方法回顾性分析梧州市人民医院2018-12—2022-12治疗的80例骑跨横窦硬膜外血肿患者的临床资料,分析患者临床特征、手术方式及预后情况,采用Logistic回归分析影响骑跨横窦硬膜外血肿患者预后不良的危险因素。结果所有意识清醒患者均伴头痛,其中频发性恶心呕吐65例,原发性昏迷10例,血压升高及脉搏减慢2例。CT检查显示枕骨骨折68例,首次CT检查发现血肿70例,迟发性血肿10例。出血来源:骨折线板障渗血35例,横窦18例,硬膜血管渗血15例,窦汇6例,乳突后导血管出血6例。伴额颞叶脑挫裂伤15例,术前CT显示环池消失15例,中线移位19例。均采用手术治疗,术后54例患者预后良好,预后良好率为67.5%,可独立生活。预后不良组入院时GCS评分低于预后良好组(P<0.05),血肿体积、入院时NIHSS评分、受伤至手术时间>24 h占比高于预后良好组(P<0.05)。Logistic回归分析显示入院时GCS评分、血肿体积、入院时NIHSS评分、受伤至手术时间>24 h均是影响骑跨横窦硬膜外血肿患者预后的独立危险因素(P<0.05)。结论骑跨横窦硬膜外血肿早期无典型临床特征,加上迟发性血肿的发生率较高,易漏诊,应尽早对患者行CT检查,密切监测患者临床症状变化,以期及时根据患者具体情况采取适宜的手术方式,有助于提升患者预后。入院时GCS与NIHSS评分、血肿体积、受伤至手术时间>24 h均是骑跨横窦硬膜外血肿患者预后不良的独立危险因素。Objective To analyze the clinical characteristics,surgical treatment and the prognosis of patients with epidural hematoma of transtransverse sinus.Methods The clinical data of 80 patients with epidural hematoma of straddle transverse sinus admitted to the People’s Hospital of Wuzhou from December 2018 to December 2022 were retrospectively analyzed.The clinical characteristics,surgical treatment and prognosis of the patients were analyzed,and the risk factors affecting the poor prognosis of the patients with epidural hematoma of the transversal sinus were analyzed by Logistic regression.Results There were 65 cases of headache,frequent nausea and vomiting,10 cases of primary coma,2 cases of high blood pressure and slow pulse.CT showed 68 cases of occipital fracture.The first CT examination revealed hematoma in 70 cases and delayed hematoma in 10 cases.The sources of bleeding were:35 cases of fracture line,18 cases of transverse sinus,6 cases of sinuses,6 cases of retropapillary vascular bleeding.There were 15 cases of frontal temporal contusion,15 cases of annulus disappearance and 19 cases of midline displacement.After operation,54 patients had a good prognosis(67.5%)and could live independently.The level of GCS score in the poor prognosis group was lower than that in the good prognosis group(P<0.05),and the proportion of hematoma volume,NIHSS at admission,injury to operation time>24 hours was higher than that in the good prognosis group(P<0.05).Logistic regression analysis showed that GCS score at admission,hematoma volume,NIHSS score at admission,and time>24 hours from injury to operation were all independent risk factors for poor prognosis in patients with transtransverse sinus epidural hematoma(P<0.05).Conclusion There are no typical clinical features in the early stage of epidural hematoma of transtransverse sinus,and the incidence of delayed hematoma is high,which is easy to miss diagnosis.Therefore,CT examination should be performed on patients as soon as possible,and the changes of clinical symptoms shou

关 键 词：骑跨横窦硬膜外血肿 临床特征 手术方式 预后 危险因素 

分 类 号：R651.15[医药卫生—外科学]