慢性硬膜下血肿术后死亡的危险因素分析

目的探讨慢性硬膜下血肿钻孔引流术后发生死亡的危险因素,以降低患者术后死亡率。方法回顾性分析我院2003年1月1日至2012年12月31日在神经外科住院接受慢性硬膜下血肿钻孔引流术患者338例,其中男196例,女142例,年龄42~90岁,平均年龄(69.83±7.715)岁。收集所有患者术前、术中、术后临床资料,建立数据库,进行单因素及Logistic多因素分析影响慢性硬膜下血肿钻孔引流术术后死亡的危险因素。结果术后死亡14例(4.14%),9例患者死于肺部感染,1例患者死于脑实质出血,1例死于大面积脑栓塞,1例死于急性心肌梗死,1例死于急性肾功能衰竭,1例死于急性肺栓塞。单因素分析结果:死亡患者年龄(P=0.000)、采用全身麻醉手术比例(P=0.003)、既往慢性阻塞性肺病(COPD)发病率(P=0.001)高于生存组;术前Glasgow评分(P=0.000)低于生存组。Logistic回归多因素分析结果:患者高龄(P=0.002;比值比(OR)=1.311;95%可信区间(CI)=1.104-1.557)、Glasgow评分低(P=0.000;OR=0.172;95%CI=0.077-0.380)、既往COPD病史(P=0.020;OR=14.333;95%CI=1.529-134.325)是慢性硬膜下血肿(CSDH)术后死亡的危险因素。结论高龄、Glasgow评分低、既往COPD病史是CSDH术后死亡的危险因素。

Risk factors of post-operative mortality for patients with chronic subdural hematoma

Objective The risk factors of post-operative mortality of burr hole craniotomy with closed drainage are investigated to decrease the mortality rate.Methods A retrospective analysis of 338 consecutive patients with chronic subdural hematomas （CSDH） treated with burr hole procedure from January 2003 to December 2012 in the Department of Neurosurgery in Anzhen Hospital was conducted.The study enrolled 196 male and 142 female patients,ranged from 42 to 90 years with an average age of （69.83 ± 7.715） years.The clinical data for all the cases were collected to establish a database.Data were analyzed by univariate analysis and multivariate Logistic regression analysis to find out the risk factors for post-operative mortality of CSDH.Results There were 14 post-operative deaths （4.14％）.In all the dead cases,9 patients died of post-operative pneumonia,1 died of intracerebral hemorrhage after evacuation of chronic subdural hemorrahge,1 died of cerebral infarction,1 died of acute myocardial infarction,1 died of acute renal failure,and 1 died of acute pulmonary thromboembolism.The univariate analysis revealed that the age （P =0.000）,the incidence of the general anesthesia using （P =0.003） and the incidence of premorbid chronic obstructive pulmonary disease （COPD） （P =0.001） in the dead group were significantly higher than those of the survival group.However,the pre-operative Glasgow scale （P =0.000） was lower in death group than in the survival group.Multi-variate Logistic regression analysis showed that aging [P =0.002;odds ratio （OR） =1.311,95％ confidence intervals（CI） =1.104-1.557],lower pre-operative Glasgow scale [P =0.000,OR =0.172,95％CI =0.077-0.380] and COPD history [P =0.020,OR =14.333,95％ CI =1.529-134.325] were independent predictors for post-operative mortality.Conclusion Aging,lower pre-operative Glasgow scale and COPD history were the risk factors for post-operative mortality after the burr hole craniotomy for patients with CSDH.