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颅脑损伤术后迟发性颅内血肿的临床研究

发布时间:2018-06-23 01:40

  本文选题:颅脑损伤 + 迟发性颅内血肿 ; 参考:《延安大学》2013年硕士论文


【摘要】:目的:探讨颅脑损伤术后迟发性颅内血肿(delayed traumatic intracranialhematoma,,DTICH)发生的相关因素、临床特点、发生机制及其防治措施。加强对本病的警惕性,重视其临床特点及发展规律,合理运用动态CT检查,争取早期诊断,早期治疗,有效提高本病的疗效和预后,降低致残率和病死率。 方法:回顾性分析2009年1月至2011年12月延安大学附属医院神经外科急性颅内血肿清除术240例患者的临床资料,其中发现术后迟发性颅内血肿的患者25例(病例组),未发生迟发性颅内血肿的患者215例(对照组)。从性别、年龄、颅脑损伤严重程度、颅脑损伤类型等方面分析这些因素与DTICH发生的关系,对观测指标的数据进行单因素分析和多因素Logistic回归分析。 结果:单因素分析显示重度颅脑损伤、脑挫裂伤、硬膜外血肿、颅骨骨折、手术时机、手术方式、TT和APTT有显著相关性(P㩳0.05);多因素Logistic回归分析显示重度颅脑损伤(OR=3.678,P=0.001)、脑挫裂伤(OR=2.374,P=0.019)、颅骨骨折(OR=1.760,P=0.024)和血浆凝血酶时间(TT)(OR=1.848,P=0.017)4个因素为DTICH的高危因素。 结论:本研究通过回顾性分析240例颅脑损伤后DTICH患者和颅脑损伤后未发生迟发性外伤性颅内血肿的临床资料,统计分析显示DTICH的发生与重度颅脑损伤、脑挫裂伤、硬膜外血肿、颅骨骨折、手术时机、手术方式、TT和APTT有显著意义(P㩳0.05)。而性别、年龄、受伤机制、硬膜下血肿、脑内血肿、首次CT时间、PT、低氧血症、低血压和术后并发症在两组中无明显差异(P㧐0.05)。将单因素分析有显著意义的自变量进行多因素Logistic回归分析,显示影响DTICH发生的危险因素重度颅脑损伤、脑挫裂伤、颅骨骨折和TT。因此,具有重度颅脑损伤、脑挫裂伤、颅骨骨折和TT等高危因素的患者易在颅脑损伤术后并发迟发性颅内血肿。鉴于颅脑损伤发生率不断上升的趋势,且死亡率和致残率高,给社会造成的巨大经济损失和身心伤害,因此我们应该重视颅脑损伤的临床救治,努力改进颅脑创伤急救体系及监测体系,加强规范化治疗和基础研究,为我们神经外科医师提供更好的理论和技术支持。如更加规范GCS评分标准,进一步改进影像学和功能检查技术,改进相关监测设备,神经干细胞移植,加强物理和康复治疗,最大限度的提高颅脑损伤救治水平,减轻颅脑损伤给社会带来的负面影响。本组研究是一项非随机、回顾性研究,因此存在潜在的偏差和变异,术后迟发性颅内血肿的患者仅为25例,样本量偏小,对于DTICH发生的危险因素、临床特点、及其相关的发生机制还有待更大样本量的资料、进行定量控制的前瞻性研究来证实,从而进一步调查与评估DTICH发生的独立危险因素。
[Abstract]:Objective: to investigate the related factors, clinical characteristics, pathogenesis and preventive measures of delayed intracranial hematoma (delayed traumatic) after craniocerebral injury. We should pay more attention to the clinical characteristics and development rules of the disease, make rational use of dynamic CT examination, strive for early diagnosis and early treatment, effectively improve the curative effect and prognosis of the disease, and reduce the rate of disability and mortality. Methods: the clinical data of 240 patients with acute intracranial hematoma removal in neurosurgery department of Yan'an University from January 2009 to December 2011 were retrospectively analyzed. There were 25 cases of delayed intracranial hematoma (case group) and 215 cases of control group (control group). The relationship between these factors and DTICH was analyzed from gender, age, severity of craniocerebral injury and type of craniocerebral injury. Univariate analysis and multivariate logistic regression analysis were used to analyze the data of observed indexes. Results: univariate analysis showed that severe craniocerebral injury, cerebral contusion and laceration, epidural hematoma, skull fracture, timing of operation, mode of operation and APTT were significantly correlated (P0. 05). Multivariate logistic regression analysis showed that the risk factors of DTICH were severe craniocerebral injury (OR3. 678), cerebral contusion and laceration (OR2. 374 P0. 019), skull fracture (OR1. 760) and plasma thrombin time (TT) (OR1. 848P0. 017). Conclusion: the clinical data of 240 patients with DTICH after craniocerebral injury and no delayed traumatic intracranial hematoma after craniocerebral injury were analyzed retrospectively. The statistical analysis showed that DTICH was associated with severe craniocerebral injury, cerebral contusion and laceration, and epidural hematoma. There were significant differences in cranial fracture, surgical timing, operation mode, TT and APTT (P < 0.05). Sex, age, injury mechanism, subdural hematoma, intracerebral hematoma, PTT, hypoxemia, hypotension and postoperative complications were not significantly different between the two groups (P0. 05). Multivariate logistic regression analysis showed that the risk factors of DTICH were severe craniocerebral injury, brain contusion and laceration, skull fracture and TTT. Therefore, patients with high risk factors such as severe craniocerebral injury, brain contusion, skull fracture and TT are prone to develop delayed intracranial hematoma after craniocerebral injury. In view of the increasing incidence of craniocerebral injury and the high mortality and disability rate, the great economic loss and physical and mental injury caused to the society, we should pay attention to the clinical treatment of craniocerebral injury. To improve the first aid system and monitoring system of craniocerebral trauma, to strengthen the standardized treatment and basic research, to provide better theoretical and technical support for our neurosurgeons. Such as more standardized GCS scoring standards, further improvement of imaging and functional examination techniques, improvement of related monitoring equipment, transplantation of neural stem cells, enhancement of physical and rehabilitation treatment, and maximum improvement of the level of treatment for craniocerebral injury. To reduce the negative effects of brain injury on society. This study was a non-random and retrospective study, so there were potential deviations and variations. There were only 25 patients with delayed intracranial hematoma after operation. The sample size was small. The clinical characteristics of DTICH were analyzed. Further investigation and evaluation of the independent risk factors of DTICH can be carried out through prospective quantitative control studies.
【学位授予单位】:延安大学
【学位级别】:硕士
【学位授予年份】:2013
【分类号】:R651.15

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