微创幕上血肿抽吸引流术后患者死亡相关因素分析

目的探讨幕上脑出血患者行微创血肿抽吸引流术预后的影响因素。方法回顾性分析2009年1月~2013年1月我科采用微创颅内血肿抽吸引流术治疗的129例幕上脑出血患者的临床资料,并对可能影响其预后及死亡的相关因素进行单因素和多因素分析。结果术后死亡16例(12.4%)。单因素分析结果显示患者术前血肿体积(P=0.021或P=0.013)、GCS评分(P=0.011)、糖尿病史(P=0.045)及高血压病史(P=0.039)是影响预后的相关因素,多因素分析显示术前GCS评分(≤8)是患者术后死亡的独立危险因素。结论术前GCS评分≤8是预测幕上脑出血患者血肿抽吸引流术术后死亡风险的独立危险因素,应根据患者意识状态合理选择治疗方案。     

手术治疗高血压脑出血短期预后因素分析

【摘要】 目的 探讨影响手术治疗高血压脑出血患者短期预后的相关因素,为指导临床和预后评估提供依据。方法 回顾性分析我院神经外科自2000年1月至2009年12月间收治的76例经手术治疗的高血压脑出血病例。入院时年龄、体重指数、收缩压、血肿体积、入院GCS评分、脑室是否有积血、是否出现肺部感染等资料为自变量,发病后3个月功能性评定(FIM)评分为因变量;利用t检验、方差分析以及线性相关分析,建立多重线性回归模型,筛选有意义的影响因素并确定其影响力。结果 体重指数、血肿体积、入院GCS评分、入院时收缩压水平、是否肺部感染等因素均与手术治疗高血压脑出血的短期预后相关。结论 高血压脑出血与多种因素相关。体重指数、血肿体积、入院GCS评分、入院时收缩压水平、是否肺部感染5因素是高血压脑出血短期预后的关键性预测因素。临床中应加强对这些因素的治疗、控制和预防。     

学龄前儿童中重型颅脑损伤预后不良相关因素分析

目的探讨学龄前儿童中重型颅脑损伤预后不良相关因素。方法 2016年2月～2019年9月,我院收治的学龄前中重型颅脑损伤患儿143例,按照患儿出院时格拉斯哥预后评分(GOS)分为预后良好组(112例)与预后不良组(31例)。采用单因素分析影响学龄前儿童中重型颅脑损伤患儿预后不良相关因素;采用多因素Logistic回归分析影响学龄前儿童中重型颅脑损伤患儿预后独立危险因素。观察指标包括性别、年龄、体温、格拉斯哥昏迷指数评分(GCS)、血乳酸、低血压、脉搏、呼吸、凝血障碍、心肌损害、肝功能损害、感染、干预方法和干预时间窗。结果 143例患儿,预后良好112例,预后不良31例。单因素分析结果显示,两组性别、年龄、体温、血钠、血钾、低血压、脉搏、呼吸、心肌损害、肝功能损害和干预方法比较差异无统计学意义(P0.05);两组GCS评分、血乳酸、凝血障碍、感染和干预时间窗方法比较差异有统计学意义(P0.05)。将上述单因素分析差异具有统计学意义的因素纳入多因素Logistic回归分析显示,GCS评分、血乳酸、凝血障碍、感染和干预时间窗为影响学龄前儿童颅脑损伤预后不良危险因素。结论学龄前儿童中重型颅脑损伤预后不良受多因素影响,其中GCS评分、血乳酸、凝血障碍、感染和干预时间窗为其危险因素。     

重度外伤性颅脑损伤早期预后不良危险因素分析

目的 探讨重度外伤性颅脑损伤早期预后不良的危险因素，为早期准确识别预后不良高危人群、指导后续治疗方案制定及最大限度改善临床预后提供参考。方法 回顾性纳入本院2020年1月至2022年12月收治重度外伤性颅脑损伤患者共192例，根据术后随访3个月格拉斯哥昏迷量表评分评估早期预后并分为以下两组：预后不良组（119例）和预后良好组（73例）；采用单因素和多因素法确定重度外伤性颅脑损伤早期预后不良独立危险因素，分析早期预后不良与实验室指标的关系，并进一步描绘受试者工作特征（ROC）曲线评估上述独立危险因素用于重度外伤性颅脑损伤早期预后不良风险预测临床效能。结果 单因素分析结果显示，年龄、中性粒细胞计数、淋巴细胞计数、中性粒细胞-淋巴细胞比值（NLR）水平、血小板-淋巴细胞比值（PLR）水平及中性粒细胞-淋巴细胞和血小板比值（N/LP）水平均可能与重度外伤性颅脑损伤早期预后不良有关（P<0.05）;Logistic回归模型多因素分析结果显示，年龄增加、入院时低格拉斯哥昏迷量表评分、高NLR水平、高PLR水平及高N/LP水平均是重度外伤性颅脑损伤早期预后不良独立危险因素（P<0.05）...     

外伤性肠破裂的治疗与相关性因素分析

目的研究分析外伤性肠破裂的治疗及影响预后的相关性因素。方法回顾性分析本院2006年1月至2013年12月收治的124例外伤性肠破裂患者资料,分其治疗和愈合情况,并根据愈合情况将其分为A组(愈合良好)和B组(愈合不良),对两组患者相关的危险因素进行单因素分析及多因素Logistic回归分析。结果既往存在糖尿病病史、发病时伴有休克症状、外伤后至手术时间长短及新损伤严重度评分(NISS)等因素在A,B组间存在显著差异(P<0.05),多因素Logistic回归分析显示,糖尿病(OR=1.63)、伤后至手术时间(OR=3.54)和NISS(OR=2.58)为外伤性肠破裂愈合不良的独立危险因素(P<0.05)。结论糖尿病、伤后至手术时间和高NISS是影响外伤性肠破裂预后不良的独立危险因素,准确判断病情,早期诊断,及时手术治疗可有效提高患者的预后和减少死亡率.     

自发性基底节区脑出血血肿扩大的危险因素分析

目的通过回顾性病例对照研究识别并验证基底节脑出血血肿扩大的危险因素,指导临床脑出血患者的救治。方法回顾性地纳入2017年1月至2019年3月本院收治的非创伤性基底节区脑出血患者145例,收集年龄、性别、个人史、既往病史及合并症、入院时血压、入院GCS评分、影像学资料以及急诊手术情况等临床资料,按照血肿有无扩大分为血肿扩大组及血肿未扩大组,通过二元逻辑回归方法识别独立危险因素。结果结果提示院前应用抗血小板药物(P=0.049,OR=10.041,95%CI=1.013～99.518)及血肿密度不均匀(P=0.031,OR=5.385,95%CI=1.165～24.888)预测血肿扩大具有统计学意义。结论院前应用抗血小板药物和CT影像血肿密度不均匀是自发性脑出血基底节区血肿扩大的独立危险因素。     

重型颅脑外伤性脑梗死的发生率及其危险因素分析

目的调查重型颅脑外伤性脑梗死的发生率,分析其发生的危险因素。方法回顾性分析208例重型颅脑外伤患者,收集年龄、性别、入院时间、入院时GCS评分、蛛网膜下腔出血、中线移位、环池形态、脑疝、急诊手术、创伤严重程度评分和APACHEⅡ评分等资料,计算重型颅脑外伤性脑梗死的发生率,采用多因素分析确定重型颅脑外伤性脑梗死发生的危险因素。结果 31例(14.9%)重型颅脑外伤患者发生外伤性脑梗死。多因素分析显示,脑疝(OR=6.421,95%CI=2.312～22.517,P=0.001)和GCS评分(OR=0.422,95%CI=0.233～0.851,P=0.002)是重型颅脑外伤并发脑梗死的独立危险因素。结论重型颅脑外伤性脑梗死的发生率较高,伤情和并发脑疝是重型颅脑外伤性脑梗死发生的独立危险因素。     

轻中度创伤性脑损伤后发生进展性出血性损伤的危险因素分析

目的探讨轻中度[格拉斯哥昏迷量表(Glasgow coma scale,GCS)≥9]创伤性脑损伤(traumatic brain injury,TBI)后发生进展性出血损伤(progressive hemorrhagic injury,PHI)的相关危险因素。方法回顾性分析2013年9月~2015年8月132例轻中度TBI患者颅内出血进展情况,41例(31.1%)进展为PHI(PHI组)。单因素分析包括性别、年龄、受伤原因、损伤类型、瞳孔大小、瞳孔对光反应、入院时高血压(收缩压≥140 mm Hg)、受伤到首次CT检查时间、血肿部位、血肿类型、是否合并脑挫裂伤、是否合并蛛网膜下腔出血,以及入院首次凝血功能指标、血糖、血常规、肾功能,出院时格拉斯哥预后评分(Glasgow outcome scale,GOS),并应用logistic回归进行多因素分析。结果单因素分析显示年龄、损伤类型、入院时高血压、合并脑挫裂伤、合并蛛网膜下腔出血、D-二聚体、红细胞计数、血糖和出院GOS评分的差异有统计学意义(P0.05)。多因素分析显示入院时高血压(OR=2.417,P=0.045),合并脑挫裂伤(OR=2.792,P=0.017)和D-二聚体≥6500μg/L(OR=4.968,P=0.000)是独立危险因素。结论轻中度TBI患者若存在入院时高血压、合并脑挫裂伤和较高水平D-二聚体(≥6500μg/L)更易发生PHI,需要加强监测。     

急性弥漫性脑肿胀预后因素分析

目的研究急性弥漫性脑肿胀的预后因素.方法将本院1996年1月至2003年2月收治的38例急性弥漫性脑肿胀病人,根据GCS评分,中线移位,基底池、手术及瞳孔情况分析其对预后的影响,统计采用逐步Lonisitic回归分析.结果统计分析表明,基底池及瞳孔情况被引入最终结果.结论基底池闭塞、瞳孔散大,是影响急性弥漫性脑肿胀患者预后的危险因素.且其对预后的影响大小依次为瞳孔散大、基底池闭塞.     

外伤性基底节区出血的临床分析

目的分析外伤性基底节区出血的临床特征。方法分析本院2009年1月至2011年1月，14例外伤性基底节区出血的临床资料，即GCS评分、瞳孔、血压、血氧饱和度、血常规、凝血功能常规、影像学资料、治疗方式和预后。结果外伤性基底节区出血占同期颅脑外伤的2．8％。所有病例均无低血压、贫血、缺氧和凝血功能异常，仅1例有高血压，余无高血压。常并发各种颅内外损伤，其中71％（10／14）并发弥漫性轴索损伤。基底节区的血肿均行保守治疗，3例因其它损伤接受手术治疗。11例恢复良好，2例轻度残疾，1例植物状态。结论外伤性基底节区出血发病率低，常并发其它颅内外损伤（尤其是弥漫性轴索损伤），经过保守治疗预后良好。     

Bilateral traumatic hemorrhage in the basal ganglia: report of two cases

Hematomas of the basal ganglia in head injury have long been recognized by pathologists with an interest in head injury but their mechanism has not been revealed clearly. We report two cases of bilateral traumatic hemorrhage in the basal ganglia. Case #1, a 17-year-old male was admitted to our hospital immediately after a traffic accident. Neurological examination revealed that the patient was comatose and had right hemiparesis. CT scan showed bilateral hemorrhage of the basal ganglia and subarachnoid hemorrhage in the perimesencephalic cistern. MRI showed high signal intensity areas in the bilateral basal ganglia, perimesencephalic cistern, cerebral white matter and corpus callosum. The patient was diagnosed as having diffuse axonal injury coinciding with bilateral hemorrhage of the basal ganglia. Stereotactic aspiration for the hematoma of the left basal ganglia was carried out. Case #2, a 75-year-old male was admitted immediately after falling from the roof of his house. Neurological examination revealed no neurological deficit except for headache and nausea. CT scan on the day of injury revealed no abnormality. But CT scan 12 hours following the injury showed bilateral hemorrhage of the basal ganglia. Blood pressure of the patient was within normal range and he was diagnosed as having traumatic bilateral intracerebral hematoma. Conservative treatment was carried out and the patient was discharged 7 days after injury with no neurological deficit. The mechanism of traumatic hemorrhage of the basal ganglia has not been clear. In case #1, diffuse axonal injury (DAI) may have played an important role in the bilateral hemorrhage. But in case #2, non-DAI factor such as vasoparalysis syndrome may have existed.(ABSTRACT TRUNCATED AT 250 WORDS)     

Massive traumatic hematoma localized in the basal ganglia: treatment by CT-guided stereotactic aspiration surgery

A case of massive traumatic hematoma of the basal ganglia which was treated successfully by CT-guided stereotactic aspiration surgery, was reported. A 6-year-old boy was admitted 2 hours after a traffic accident. He had no neurological focal signs except for disturbance of consciousness on admission. CT scan revealed a massive hematoma in the right basal ganglia. His neurological status gradually deteriorated 6 hours after the trauma and the size of the hematoma increased on serial CT scan. Then, CT-guided stereotactic aspiration surgery was performed and about 15.5 ml of hematoma clot was successfully evacuated. He made an uneventful recovery from the operation and gradually improved. The final outcome was that he showed moderate disability at 3 months after the trauma. The possible mechanism of development of hematoma in this lesion, and indication of CT-guided stereotactic aspiration surgery were also discussed.     

急性外伤性颅内血肿开颅血肿清除术后迟发血肿相关因素的Logistic回归分析

目的研究急性外伤性颅内血肿开颅血肿清除术后迟发血肿的相关因素。方法收集记录271例急性外伤性颅内血肿开颅手术治疗患者的临床资料．对相关因素进行二分类单因素及多因素Logistic回归分析。结果52例患者术后迟发血肿。单因素回归分析得到持续昏迷、Babinski征阳性、颅骨骨折等12个变量有统计学意义（P〈0．05）．多因素回归分析得到血浆凝血酶时间（P=0．027,OR=1．154）、Babinski征阳性（P=0．000,OR=4．107）、颅骨骨折（P=0．000,OR=4．980）为术后迟发血肿的危险因素,手术时机（P=0．016,OR=0．91）为保护因素。结论对入院时Babinski征阳性、血浆凝血酶时间明显延长、合并颅骨骨折且早期急诊手术治疗的重型颅脑损伤患者在术后早期需警惕迟发血肺的发生。     

Intracranial hemorrhage secondary to von Willebrand's disease and trauma

A rare juvenile case of traumatic hemorrhage in the basal ganglia with intraventricular hematoma, associated with von Willebrand's disease, is reported. Hemostatic management of von Willebrand's disease and our surgical method for treatment of intraventricular hemorrhage are discussed briefly.     

急性颅脑损伤后进展性出血性损伤危险因素分析

目的探讨急性颅脑损伤后发生进展性出血性损伤危险因素。方法分析274例你和性颅脑外伤患者临床资料,分为进展组86例和非进展组188例,对照分析两组相关因素。结果两组除首次头颅CT时间外,年龄、性别、GCS评分、瞳孔扩大、平均动脉压、合并颅骨折、合并硬膜外血肿、合并脑挫伤、合并蛛网膜下腔出血、双侧伤、首次CT血肿量、两次CT血肿量差之间差异,均有统计学意义(P均<0.05)。GCS<12分、瞳孔扩大、合并脑挫伤、合并蛛网膜下腔出血及首次CT血肿量>10ml为发生进展性出血性损伤的独立危险因素(P均<0.05)。结论急性颅脑损伤患者及时进行头颅CT检查,对血肿量>10ml,GCS评分1<12分、瞳孔扩大及合并脑挫伤和蛛网膜下腔出血患者,应密切观察病情进展,尽早复查头颅CT以及时发现进展性出血性损伤。     

软通道定向钻孔引流术治疗基底核区HICH患者的疗效及术后复发的Logistics分析

目的 探讨软通道定向钻孔引流术治疗基底核区高血压脑出血(HICH)患者的疗效及术后复发的危险因素.方法 回顾性分析2017-01-2020-04间揭西县棉湖华侨医院外一科收治的62例高血压脑出血患者的临床资料.重点分析患者的临床资料、治疗方法和效果,以及术后再出血因素.结果 男40例,女22例;年龄(63.37±7.4...     

超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血

目的总结超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血经验。方法2001年3月～2005年2月，我科对33例高血压性基底节脑出血6h内超早期手术，采用小骨窗开颅，经外侧裂、岛叶入路，显微镜下清除血肿，去骨瓣减压，不放引流，术后严格控制高血压。结果术后CT复查血肿清除彻底。术后肺炎2例。按格拉斯哥预后评分标准随访3个月，良好23例，中残10例。结论超早期小骨窗外侧裂入路显微手术治疗高血压性基底节脑出血，具有创伤小，清除血肿彻底，并发症和致残率低，恢复功能快等优点。     

翼点入路经岛叶显微手术治疗基底节区高血压脑出血

【摘要】〓目的〓探讨基底节区高血压脑出血显微手术疗效。方法〓回顾性分析23例翼点入路经岛叶显微手术治疗的基底节区高血压脑出血患者的临床资料。 结果〓术后24 h复查头颅CT,血肿清除率 > 90%者21例(91.3%)。术后随访6~36个月,根据日常生活能力分级,Ⅰ级8例,Ⅱ级9例,Ⅲ级3例,Ⅳ级2例。Ⅴ级1例。 结论〓翼点入路经岛叶显微手术治疗基底节区高血压脑出血,血肿清除率高、神经功能恢复较好。     

急性外伤性脑脊液鼻漏、耳漏合并颅内血肿的手术治疗

目的总结颅底骨折所致急性脑脊液鼻漏、耳漏合并颅内血肿的手术治疗效果. 方法对37例患者进行手术治疗,在清除颅内血肿的同时行硬脑膜修补,骨蜡、肌肉组织填塞颅底骨折缝隙、额窦、乳突气房,硬脑膜漏口及颅底骨折均用EC耳脑胶粘合以加固修补. 结果术后33例脑脊液漏一次性治愈;1例鼻漏患者术后15 d漏液,经再次修补治愈;1例颅内感染(脑膜炎),经腰穿鞘内注射噻吗灵治愈;2例直接死于颅脑损伤. 结论急性外伤性脑脊液鼻漏、耳漏合并颅内血肿有手术指征者,血肿清除后应在硬脑膜水平进行漏口修补,同时将颅底骨折缝隙、破裂的额窦、乳突、筛板严密封闭,可有效预防术后颅内感染.     

Simultaneous multiple hypertensive intracerebral hematoma

Hypertensive intracerebral hemorrhage (HIH) occurring simultaneously in different locations is rare. We encountered 11 such cases between January 1990 and November 2002. The diagnosis of all 11 cases was established by computed tomography, and the location of the hematomas was: cerebellum and basal ganglia in 5 cases, pons and basal ganglia in 4, and subcortex and basal ganglia in 2. Our patients were analyzed with respect to clinical characteristics, pathogenesis of multiple hematomas, and indication of operation. These patients represented 1% of all 1,069 patients we encountered with HIH. As past history, there were no characteristic disorders except hypertension. There were no characteristic initial symptoms suggesting that hemorrhage had occurred simultaneously. Both supra- and infra-tentorial hematomas were observed in 80% of the patients, and the size of the multiple hematomas was proportional in principle. Cerebellar hematomas were often mild, and pontine hematomas were often severe. The outcome in those patients whose neurological grading was 1 to 3 was good with conservative therapy or surgical treatment. The severity, treatment methods, and outcomes in these patients were similar to those in patients with single HIH, which suggests only a slight influence of multiple lesions on outcome. As for the possible mechanism of simultaneous multiple hemorrhages, we speculated that bleeding occurred simultaneously in the different regions, or that the initial bleeding was followed after a short time by secondary bleeding due to high intracranial pressure and circulatory disturbance. In patients with cerebellar hematoma, initial symptoms suggested the development of secondary hemorrhage after primary hemorrhage. The surgical treatment for multiple hematomas should be determined by the location and maximum axis of the hematoma. We proposed that cerebellar hematomas should be removed if the supra-tentorial hematoma is small.