慢性硬膜下血肿钻孔引流术后颅内积气对预后影响的临床研究

发布时间：2018-04-21 19:30

本文选题：慢性硬膜下血肿 + 钻孔冲洗引流术　；参考：《蚌埠医学院》2017年硕士论文

【摘要】：目的:探讨慢性硬膜下血肿(Chronic subdural haematoma,CSDH)钻孔引流术后颅内积气对预后的影响。方法:1.对140例行钻单孔冲洗引流术的慢性硬膜下血肿患者进行前瞻性研究,使用Onis2.3.5 Image proplus软件测量患者术前血肿量及术后第1天和术后4-10天时颅内的血肿残留量,运用计算机辅助设计(Any CAD Viewer 5.0.)和计算机辅助制造(Any CAM Viewer 5.0.)软件分别计算术后第1天、术后4-10天、术后1月的颅内积气量。记录患者术前的GCS评分、血肿部位、有无外伤史等,记录患者出院时GCS评分、3个月后随访的GOS评分、是否感染或复发等。2.将患者术前颅内血肿量,分别与术后第1天头颅CT颅内积气量和血肿残留量进行pearson直线相关分析;将患者术后第1天头颅CT颅内积气量,分别与术后第1天颅内血肿残留量、出院时GCS评分、3个月后随访的GOS评分进行pearson直线相关分析;将患者术后4-10天时颅内积气量与术后3个月的GOS评分进行pearson直线相关分析。术后第1天、术后4-10天、术后1月左右时颅脑CT所示的颅内积气量之间差异进行单因素方差分析。结果:140例慢性硬膜下血肿患者术前颅内血肿量为114.66±25.10ml,临床症状结合影像学资料分析均行硬膜下钻单孔冲洗引流术。患者术后第1天颅内积气量为28.63±26.96ml,颅内血肿残留量为13.11±11.27ml;出院时GCS评分为14.74±1.05,术后3个月GOS评分为4.79±0.53。pearson相关性统计分析发现患者术后第1天头颅CT颅内积气量与患者术前颅内血肿量呈正相关(P0.05);患者术后第1天头颅CT颅内血肿残留量与患者术前颅内血肿量具有正相关(P0.05);患者术后第1天头颅CT颅内积气量与患者出院时GCS评分之间无统计学相关性(P0.05),患者出院时GCS评分与患者术后第1天头颅CT颅内血肿残留量之间具有正相关(P0.05);患者术后3个月GOS评分与患者术后第1天头颅CT颅内积气量之间无统计学相关性(P0.05);患者术后3个月GOS评分与患者术后4-10天时头颅CT颅内积气量之间无统计学相关性(P0.05)。术后第1天、术后4-10天、术后1月左右时颅内积气量之间差异具有显著统计学意义(P0.05)。结论:慢性硬膜下血肿钻孔冲洗引流术后一定范围内的积气量对患者预后无明显影响。
[Abstract]:Objective: to investigate the effect of intracranial gas accumulation on the prognosis of chronic subdural hematoma (Chronic subdural haematoma subdural). Method 1: 1. A prospective study was carried out on 140 patients with chronic subdural hematoma who underwent single hole drilling irrigation and drainage. The preoperative hematoma volume was measured by Onis2.3.5 Image proplus software, and the residual intracranial hematoma was measured on the first day after operation and 4-10 days after operation. Any CAD Viewer 5.0) Any CAM Viewer 5.0) Intracranial air accumulations were calculated on the first day, 4-10 days and 1 month after operation. The preoperative GCS score, hematoma location, history of trauma, GCS score at discharge, GOS score after 3 months follow-up, infection or recurrence were recorded. The preoperative intracranial hematoma volume was analyzed by pearson linear correlation analysis with the intracranial air accumulation and hematoma residue on the first day after operation, and the intracranial hematoma volume on the first day after operation was compared with the intracranial hematoma residue on the first day after operation. The GCS score at discharge and the GOS score at 3 months follow-up were analyzed by pearson linear correlation analysis and pearson linear correlation analysis was performed between the intracranial air accumulation at 4-10 days after operation and the GOS score at 3 months after operation. Univariate analysis of variance (ANOVA) was performed on the first day, 4-10 days and 1 month after operation. Results the volume of intracranial hematoma was 114.66 卤25.10 ml in 140 patients with chronic subdural hematoma before operation. On the first day after operation, the volume of intracranial gas accumulation was 28.63 卤26.96 ml, the residual amount of intracranial hematoma was 13.11 卤11.27 ml, the GCS score at discharge was 14.74 卤1.05, and the GOS score at 3 months after operation was 4.79 卤0.53.pearson. There was a positive correlation between the amount of intracranial hematoma and the amount of intracranial hematoma before operation on the first day after operation, and there was no correlation between the volume of intracranial hematoma on the first day after operation and the GCS score of the patient at the first day after operation, and there was a positive correlation between the amount of intracranial hematoma and the amount of intracranial hematoma on the first day after operation. There was a positive correlation between the GCS score at discharge and the residual amount of intracranial hematoma on the first day after operation (P 0.05), but there was no correlation between the GOS score at 3 months after operation and the intracranial air accumulation on the first day after operation. There was no significant correlation between the GOS score 3 months after operation and the intracranial volume of air accumulation on cranial CT at 4-10 days after operation (P 0.05). There were significant differences in intracranial air accumulation on the first day, 4-10 days and 1 month after operation (P 0.05). Conclusion: there is no significant effect on the prognosis of patients with chronic subdural hematoma.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15

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