重型颅脑损伤去大骨瓣减压术后发生迟发性颅内血肿的危险因素分析  

Risk factors for delayed intracranial hematoma after decompressive craniectomy for severe craniocerebral injury

作　　者：张艳[1] 魏玮 韩丹 Zhang Yan;Wei Wei;Han Dan(Ward Ⅱ,Department of Neurosurgery,Nanyang Central Hospital,Nanyang 473000,China;Department of Medical Insurance Management,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]南阳市中心医院神经外科三病区,南阳473000 [2]南阳市中心医院医保管理科,南阳473000

出　　处：《中国实用医刊》2024年第15期52-55,共4页Chinese Journal of Practical Medicine

摘　　要：目的探讨重型颅脑损伤去大骨瓣减压术(DC)后发生迟发性颅内血肿(DIH)的危险因素。方法抽取2020年5月至2023年4月于南阳市中心医院行DC的80例重型颅脑损伤患者的临床资料进行回顾性分析,按照术后是否发生DIH将其分为DIH组(23例)和非DIH组(57例)。收集并比较两组受伤至手术时间、颅骨骨折情况、术前格拉斯哥昏迷评分(GCS)评分、纤维蛋白原(FIB)、凝血酶时间(TT)、硬膜外血肿等临床资料,分析重型颅脑损伤DC后发生DIH的相关因素。结果两组受伤至手术时间、颅骨骨折情况、术前GCS评分、FIB、TT、硬膜外血肿情况比较差异有统计学意义(P<0.05)。Logistic回归分析结果显示,受伤至手术时间长、颅骨骨折、术前GCS评分≤5分、FIB低、TT高、硬膜外血肿是重型颅脑损伤DC后发生DIH的危险因素(P<0.05)。结论重型颅脑损伤DC后发生DIH的影响因素较多,受伤至手术时间长、颅骨骨折、术前GCS评分≤5分、FIB低、TT高、硬膜外血肿是DIH的危险因素,临床需积极采取有效预防措施以降低术后DIH发生风险,改善患者预后。Objective To investigate the risk factors for delayed intracranial hematoma(DIH)after decompressive craniectomy(DC)for severe craniocerebral injury.Methods The clinical data of 80 patients with severe craniocerebral injury who underwent DC in Nanyang Central Hospital from May 2020 to April 2023 were selected for the retrospective analysis,and they were divided into a DIH group(23 cases)and a non-DIH group(57 cases)according to whether DIH occurred after surgery.The clinical data,including injury-to-operation time,skull fracture,preoperative Glasgow coma scale(GCS)score,fibrinogen(FIB),thrombin time(TT)and epidural hematoma,of the two groups were collected and compared;and the factors related to the occurrence of DIH after DC for severe craniocerebral injury were analyzed.Results There were statistically significant differences in injury-to-operation time,skull fracture,preoperative GCS score,FIB,TT and epidural hematoma between the two groups(P<0.05).Results of logistic regression analysis showed that long injury-to-operation time,skull fracture,preoperative GCS score≤5,low FIB,high TT,and epidural hematoma were the risk factors for DIH after DC for severe craniocerebral injury(P<0.05).Conclusions There are various influencing factors for DIH after DC in patients with severe craniocerebral injury,including long time from injury to operation,skull fracture,preoperative GCS score of≤5,low FIB,high TT,and epidural hematoma.It is necessary to take effective preventive measures to reduce the risk of postoperative DIH,so as to improve the prognosis of patients.

关 键 词：颅脑损伤 去大骨瓣减压术 迟发性颅内血肿 

分 类 号：R651.15[医药卫生—外科学]