颅骨修补术后硬膜外积血/积液的危险因素分析及防治措施  

Risk factors analysis and preventive measures for epidural hemorrhage/effusion after cranioplasty

作　　者：吴宏彬 陶晓刚 田润发[1] 王翀昊[1] 吴量[1] 刘伟明[1] 高国一 刘佰运[1] Hongbin Wu;Xiaogang Tao;Runfa Tian;Chonghao Wang;Liang Wu;Weiming Liu;Guoyi Gao;Baiyun Liu(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Neurosurgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 453003,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100070 [2]郑州大学第一附属医院神经外科,郑州453003

出　　处：《中华神经创伤外科电子杂志》2024年第3期141-146,共6页Chinese Journal Of Neurotraumatic Surgery:Electronic Edition

基　　金：2022年宁波市重点研发计划(2022Z143)

摘　　要：目的分析颅骨修补术后硬膜外积血/积液的危险因素及其防治措施。方法回顾性分析首都医科大学附属北京天坛医院神经外科颅脑创伤病区自2016年12月至2023年10月接受颅骨修补术治疗的463例患者的临床资料,根据术后是否有积血/积液,将患者分为有积血/积液组和无积血/积液组,比较2组患者的临床资料,采用多因素Logistic回归分析筛选颅骨修补术后硬膜外积血/积液的危险因素。结果463例颅骨修补患者中37例患者术后发生了硬膜外积血/积液,发生率为7.99%,其中33例患者使用引流管+尿激酶灌注进行充分引流后好转,4例患者进行了二次开颅手术清除积血/积液。组间比较显示,2组患者的性别、单侧/同期双侧修补、术中出血量、引流管类型、负压吸引比较,差异具有统计学意义(P<0.05);将P<0.1的因素进一步纳入多因素Logistic回归分析显示,年龄增大、男性、同期双侧修补、百多安引流管系统是颅骨修补术后硬膜外积血/积液的独立危险因素(P<0.05)。结论年龄增大、男性、同期双侧修补、百多安引流管系统是颅骨修补术后硬膜外积血/积液的独立危险因素。围术期关注危险因素,提高手术技巧,严格规范操作,彻底止血,并且术后有效引流能显著减少颅骨修补术后硬膜外积血/积液甚至血肿的发生。Objective To analyze the risk factors for epidural hemorrhage/effusion after cranioplasty and discuss preventive and therapeutic measures.Methods A retrospective analysis was conducted on 463 patients who underwent cranioplasty in Neurosurgery Department of Beijing Tiantan Hospital,Capital Medical University from December 2016 to October 2023.Patients were divided into two groups based on whether there was postoperative hematoma/effusion:the group with hematoma/effusion and the group without hematoma/effusion.The clinical data of the two groups were compared,and multiple Logistic regression analysis was used to screen for prognostic factors.Results Among the 463 cranioplasty patients,37 developed postoperative epidural hemorrhage/effusion,with an incidence rate of 7.99%.Among them,33 patients improved after sufficient drainage using a drainage tube and urokinase perfusion,while 4 patients required a second craniotomy to evacuate the hemorrhage/effusion.The intergroup comparison showed that there were statistically significant differences in gender,unilateral/simultaneous bilateral repair,intraoperative blood loss,drainage tube type,and negative pressure suction between the two groups of patients(P<0.05);Multivariate Logistic regression analysis of factors with P<0.1 revealed that advanced age,male gender,simultaneous bilateral cranioplasty,and the use of a Branden external drainage system were independent risk factors for postoperative epidural hematoma/effusion following cranioplasty(P<0.05).Conclusion Advanced age,male gender,simultaneous bilateral cranioplasty,and the use of a Branden external drainage system were independent risk factors for postoperative epidural hematoma/effusion following cranioplasty.Attention to these risk factors during the perioperative period,improvement of surgical techniques,strict adherence to standardized procedures,thorough hemostasis and effective postoperative drainage can significantly reduce the incidence of epidural hemorrhage/effusion or even hematoma after cranioplasty.

关 键 词：颅骨修补 硬膜外积血 硬膜外积液 去骨瓣减压 危险因素 

分 类 号：R651.1[医药卫生—外科学]