急性外伤性硬膜下血肿患者术后生存状况研究

目的探讨急性外伤性硬膜下血肿患者的术后生存状况。方法选择2012年1月至2015年5月在本院就诊的急性外伤性硬膜下血肿患者90例,根据患者术后生存状况,将所有患者分为存活组和死亡组。对两组患者的预后指标进行评估,术前因素包括患者年龄、性别、昏迷指数评分(GCS)、术前有无脑疝,术后因素包括脑肿胀程度、脑搏动分级,术中因素包括有无伴发蛛网膜下腔出血、术中血肿量的多少、有无明确出血点。同时比较对两组患者手术前后的焦虑、抑郁评分。结果两组患者的年龄、GCS、脑疝、脑搏动等级之间差异有统计学意义(P0.05);手术后存活组患者的焦虑自评量表(SAS)得分、抑郁自评量表(SDS)评分低于死亡组患者,差异有统计学意义(P0.05)。Logistic回归分析显示,患者的年龄(OR=2.942,P=0.031)、GCS评分(OR=3.522,P=0.020)、有无脑疝(OR=1.933,P=0.043)、脑搏动(OR=1.782,P=0.005)等均是影响患者预后的重要因素。结论急性硬膜下血肿患者的年龄、术前GCS评分、术前有无脑疝、脑搏动恢复程度均是影响患者预后的重要因素。

Survival status of patients with acute traumatic subdural hematoma

Objective To investigate the survival status of patients with acute traumatic subdural hematoma .Methods A total of 90 patients with acute traumatic subdural hematoma treated in the hospital were selected from January 2012 to May 2015 .Ac‐cording to the postoperative survival situation ,all the patients were divided into survival group and death group .The prognostic in‐dexes were evaluated .Preoperative factors included patient age ,sex ,Glasgow Coma Scale (GCS) score ,with or without preoperative cerebral hernia and postoperative factors included brain swelling ,brain wave classification .Intraoperative factors included whether the patients complicated with subarachnoid hematoma hemorrhage ,intraoperative amount of bleeding ,whether the patients had clear point or not .The score of anxiety and depression were compared between the two groups .Results There was significant difference between the two groups in age ,GCS score ,the rate of herniation ,the rank of brain pulsation (P<0 .05) .The score of self‐rating anxiety scale (SAS) and the score of self‐rating depression scale (SDS) in the survival group were significantly lower than that of the death group ,and the differences were statistical significant (P<0 .05) .Logistic regression analysis showed that patients′age (OR=2 .942 ,P= 0 .031) ,GCS score (OR= 3 .522 ,P= 0 .020) ,whether the patients had herniation or not (OR= 1 .933 ,P=0 .043) ,brain pulsation (OR=1 .782 ,P=0 .005) were the important factors which influenced the prognosis .Conclusion Age ,pre‐operative GCS score ,whether the patients companied with preoperative herniation ,degree of recovery of brain pulsation influence the prognosis of the patients with acute traumatic subdural hematoma .