重型颅脑损伤患者大骨瓣减压术后迟发性颅内血肿对预后的影响

发布时间：2018-10-07 21:22

【摘要】：目的:探讨重型颅脑损伤(sTBI)患者行单侧大骨瓣减压术(LDC)后迟发性颅内血肿(DTICH)发生的危险因素及其对预后的影响,为提高sTBI患者救治成功率提供依据。方法:回顾性分析130例行单侧LDC的sTBI患者的临床资料。依据术后是否发生DTICH分为DTICH组(n=42)和非DTICH组(n=88),对比分析DTICH发生的危险因素及其对预后的影响。结果:2组患者术前格拉斯哥昏迷评分(GCS)、外伤至手术时间、并发颅骨骨折、中线移位1cm、基底池消失、活化部分凝血酶原时间(APTT)、纤维蛋白原(FIB)、凝血酶时间(TT)与DTICH的发生有关联(P0.05)。多因素Logistic回归分析,外伤至手术时间、并发颅骨骨折、基底池消失和FIB是DTICH发生的独立危险因素(P0.05)。对比分析2组患者的3个月后格拉斯哥预后评分(GOS),DTICH组患者预后明显差于非DTICH组(P0.01)。结论:对于外伤至手术时间较短、并发颅骨骨折、基底池消失、FIB下降的患者,应高度警惕DTICH的发生。DTICH影响患者预后,提前预防和早期诊断是改善患者预后的关键。
[Abstract]:Objective: to investigate the risk factors of delayed intracranial hematoma (DTICH) after unilateral large bone flap decompression (LDC) in patients with severe craniocerebral injury (sTBI) and its influence on prognosis. Methods: the clinical data of 130 sTBI patients with unilateral LDC were analyzed retrospectively. DTICH was divided into two groups: DTICH group (n = 42) and non-DTICH group (n = 88). The risk factors of DTICH and its influence on prognosis were compared and analyzed. Results in two groups, Glasgow coma score (Glasgow coma score) was used to evaluate the time from trauma to operation, cranial fracture, midline shift 1 cm, basal cistern disappeared, activated partial prothrombin time (APTT), fibrinogen (FIB), thrombin time (TT) was associated with DTICH (P0.05). Multivariate Logistic regression analysis, traumatic to operative time, complicated skull fracture, disappearance of basal cistern and FIB were independent risk factors of DTICH (P0.05). Glasgow prognostic score (Glasgow prognostic score) was significantly worse in (GOS) group than that in non DTICH group (P0.01). Conclusion: for the patients with short time from trauma to operation, complicated with skull fracture and decreased basal cistern, the occurrence of DTICH. DTICH may affect the prognosis of the patients. Prevention and early diagnosis are the key to improve the prognosis of the patients.
【作者单位】：吉林大学中日联谊医院神经外科;
【基金】：吉林省科技厅科技发展计划项目资助课题(200705314)
【分类号】：R651.15

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