重型颅脑损伤患者大骨瓣减压术后发生迟发性颅内出血的影响因素分析  

Influencing factors of delayed intracranial hemorrhage in patients with severe traumatic brain injury after large bone flap decompression surgery

作　　者：焦莹莹 翟银镯 刘振峰 张丽[1] Jiao Yingying;Zhai Yinzhuo;Liu Zhenfeng;Zhang Li(Neurosurgery Intensive Care Unit,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院神经外科重症监护病房,郑州450000

出　　处：《中国实用医刊》2024年第24期40-43,共4页Chinese Journal of Practical Medicine

摘　　要：目的分析重型颅脑损伤患者大骨瓣减压术后发生迟发性颅内出血(DICH)的影响因素。方法前瞻性研究。抽取2023年2月至2024年2月于郑州大学第一附属医院行大骨瓣减压术的65例重型颅脑损伤患者作为研究对象, 根据术后3 d内是否发生DICH将患者分为DICH组和非DICH组。收集所有患者基线资料, 并记录实验室相关检查指标, 采用Logistic回归分析影响重型颅脑损伤患者大骨瓣减压术后发生DICH的相关因素。结果 65例重型颅脑损伤患者大骨瓣减压术后发生DICH 12例, 发生率为18.46%(12/65)。DICH组和非DICH组不同创伤至手术时间、脑挫裂伤、术后血压控制情况占比、纤维蛋白原(FIB)水平比较, 差异有统计学意义(P<0.05);多因素Logistic回归分析结果显示, 创伤至手术时间、脑挫裂伤、术后血压控制情况不理想、FIB水平是重型颅脑损伤患者大骨瓣减压术后发生DICH的影响因素(OR>1, P<0.05)。结论创伤至手术时间、脑挫裂伤、术后血压控制不理想、FIB水平是重型颅脑损伤患者大骨瓣减压术后发生DICH的影响因素。Objective To analyze the influencing factors of delayed intracranial hemorrhage(DICH)in patients with severe traumatic brain injury after large bone flap decompression surgery.MethodsSixty-five patients with severe traumatic brain injury who underwent large bone flap decompression surgery in the First Affiliated Hospital of Zhengzhou University from February 2023 to February 2024 were selected as the study subjects for the prospective study.And they were divided into a DICH group and a non DICH group based on development of DICH within 3 days after surgery.The baseline data of all patients were collected,and the laboratory related examination indexes were recorded.Logistic regression analysis was used to analyze the related factors affecting DICH after large bone flap decompression in patients with severe traumatic injury.ResultsAmong the 65 patients with severe traumatic brain injury,12 cases(18.46%)experienced DICH after large bone flap decompression surgery.There were statistical significant differences in the proportion of time from trauma to surgery,brain contusion and laceration,postoperative blood pressure control,and fibrinogen(FIB)level between the DICH group and the non DICH group(P<0.05).Multivariate Logistic regression analysis results showed that time from trauma to surgery,brain contusion and laceration,poor postoperative blood pressure control,and FIB level were the influencing factors for the occurrence of DICH in patients with severe traumatic brain injury after large bone flap decompression surgery(OR>1,P<0.05).ConclusionsThe time from trauma to surgery,brain contusion and laceration,poor postoperative blood pressure control,and FIB level are the influencing factors for the occurrence of DICH in patients with severe traumatic brain injury after large bone flap decompression surgery.

关 键 词：颅脑损伤 大骨瓣减压术 迟发性颅内出血 影响因素 

分 类 号：R65[医药卫生—外科学]