颅脑损伤去骨瓣减压术后硬膜下积液的危险因素分析

目的探讨影响颅脑损伤去骨瓣减压术后硬膜下积液发生的独立危险因素。方法回顾性分析2012年2月至2014年2月149例颅脑损伤去骨瓣减压术患者的临床资料,其中术后发生硬膜下积液47例（积液组）,未发生硬膜下积液102例（非积液组）。对其危险因素进行单因素分析和多因素Logistic回顾分析。结果两组患者入院时GCS评分、手术时机、血肿位置、血肿量、基底池受压、中线结构位移≥10 mm、蛛网膜下腔出血及脑积水发生率差异有统计学意义（P〈0.05）;多因素Logistic回归分析结果显示,入院时GCS评分≤5分、血肿量〉40 ml、中线结构位移≥10 mm、蛛网膜下腔出血、脑积水、基底池受压是颅脑损伤去骨瓣减压术后硬膜外积液的独立危险因素。结论损伤严重、血肿量大、CT表现为基底池受压和中线结构位移≥10 mm、并发蛛网膜下腔出血及脑积水的颅脑损伤患者在去骨瓣减压术后发生硬膜下积液的风险较高,应给予重视。

Analysis of risk factors related to subdural effusion after decompressive craniectomy patients with craniocerebral injury

Objective To explore the independent risk factors of subdural effusion after decompressive craniectomy in the patients with cranioeerebral injury. Methods The clinical data of 149 patients with craniocerebral injury, who received decompressive craniectomy from February, 2012 to February, 2012, were analyzed retrospectively. Of 149 patients with craniocerebral injury undergoing decompressive eraniectomy, 47 had postoperative subdural effusion （effusion group） and 102 patients not （no effusion group）. The univariable and muhivariable Logistic regression analysis were performed to understand the risk factors related to the subdural effusion. Results The univariable analysis results showed that the factors related to subdural effusion included GCS score, hematoma volume, operative opportunity, hematoma position, compression of basal cistern, midline structure displacement ≥ 10 mm, subarachnoid hemorrhage and the incidence of hydrocephalus （P〈0.05）. Muhiariable Logistic regression analysis results showed that the independent risk factors of the postoperative subdural effusion included GCS 3-5 scores on admission to hospital, hematoma volume〉 40 ml, midline structure displacement≥ 10 mm, subarachnoid hemorrhage, hydrocephalus and compression of basal cistern in the patients with cranioeerebral injury. Conclusion There is a higher risk of subdural effusion after decompressive craniectomy in the patients with craniocerebral injury who have serious injury, a large hematoma volume, compression of basal cistern on CT imaging, midline structure displacement ≥ 10 mm, subarachnoid hemorrhage and hydrocephalus.