慢性硬膜下血肿并发行为异常的影响因素分析

目的研究慢性硬膜下血肿并发行为异常的影响因素。方法回顾性连续纳入2009年1月至2019年10月四川省德阳市人民医院收治的慢性硬膜下血肿207例,将所有患者依据是否并发行为异常分为行为异常组及非行为异常组。收集患者一般人口学资料如性别、年龄及病史(如外伤史、吸烟史、饮酒史、脑血管病史、高血压病史、糖尿病史、血脂异常病史、凝血异常史),记录患者入院时格拉斯哥昏迷量表(GCS)评分,收集入院时CT及脑CT灌注等影像学资料,包括血肿量、血肿部位、血肿密度、CT中线移位、镰下疝、脑灌注缺损等资料。由专业的心身医学科医师进行精神检查,并进行汉密尔顿抑郁量表(HAMD)、修订韦氏成人记忆量表(WMS-RC)及力量表(WAIS-RC)测试。以HAMD评分>7分为抑郁状态,记忆商及总智商<79分作为记忆障碍和智能障碍的判断标准。采用Logistic回归分析影响慢性硬膜下血肿并发行为异常的独立危险因素。结果慢性硬膜下血肿患者并发行为异常的发生率为73.43%(152/207)。单因素分析结果显示,两组慢性硬膜下血肿患者在性别、年龄、凝血异常史方面差异无统计学意义(均P>0.05);两组患者在外伤史(χ^2=8.763)、吸烟史≥10年(χ^2=11.491)、饮酒史≥10年(χ^2=14.365)、脑血管病史(χ^2=11.492)、高血压病史≥10年(χ^2=13.057)、糖尿病史≥10年(χ^2=9.534)、血脂异常病史(χ^2=13.274)、病程≥3个月(χ^2=7.731)、血肿量≥30 ml(χ^2=12.763)、额颞部血肿(χ^2=21.458)、混杂密度血肿(χ^2=8.736)、CT中线移位≥5 mm(χ^2=14.572)、镰下疝(χ^2=10.396)、GCS<8分(χ^2=7.216)、额颞叶脑灌注缺损(χ^2=6.781)方面比较,差异均有统计学意义(均P<0.05)。Logistic回归分析结果显示,外伤史(OR=2.164,95%CI:1.083~2.934)、吸烟史≥10年(OR=2.346,95%CI:1.191~2.835)、饮酒史≥10年(OR=2.941,95%CI:1.284~3.157)、脑血管病史(OR=3.178,95%CI:1.893~4.597)、高血压病史≥10年(OR=2.783,95%CI:1.231~2.957)、糖尿病史≥10年(OR=2.841,95%CI:1.309~3.637)、有血脂异常病史(OR=3.237,95%CI:1.794~5.124)、病程≥3个月(OR=3.957,95%CI:1.997~5.463)、血肿量≥30 ml(OR=4.875,95%CI:1.982~5.875)、额颞部血肿(OR=4.763,95%CI:1.898~5.968)、混杂密度血肿(OR=4.537,95%CI:1.795~5.362)、CT中线移位≥5 mm(OR=4.876,95%CI:1.897~5.985)、并发镰下疝(OR=4.495,95%CI:1.754~5.247)、GCS<8分(OR=4.875,95%CI:1.897~5.876)、额颞叶脑灌注缺损(OR=4.237,95%CI:1.651~4.896)是影响慢性硬膜下血肿患者并发行为异常的独立危险因素。结论慢性硬膜下血肿并发行为异常受外伤史、吸烟史、饮酒史、脑血管病史、高血压病史、糖尿病史、高血脂病史、病程、血肿量、血肿部位、血肿密度、CT中线移位、镰下疝、GCS、脑灌注等因素影响,有针对性给予干预可能有效降低慢性硬膜下血肿发生行为异常的发生率。

Influencing factors of chronic subdural hematoma complicated with behavioral abnormality

Objective To investigate the influencing factors of chronic subdural hematoma with behavioral abnormality.Methods A total of 207 cases with chronic subdural hematomaadmitted to Deyang People's Hospital of Sichuan Province from January 2009 to October 2019 were retrospectively enrolled.All patients were divided into behavior abnormality group and non behavior abnormality group according to whether there was behavior abnormality.The general demographic data such as gender,age,history of trauma,smoking,drinking,cerebrovascular disease,hypertension,diabetes,hyperlipidemia,blood coagulation,Glasgow Coma Scale(GCS)score at admission,CT and cerebral perfusion imaging data at admission,including hematoma volume,hematoma location,hematoma density,CT midline displacement,falx hernia and cerebral perfusion defect.Mental examination was carried out by a professional psychosomatic physician,and Hamilton Depression Scale(HAMD),revised Wechsler Adult Memory Scale(WMS-RC)and Strength Scale(WAIS-RC)were tested.The scores of HAMD>7 were regarded as depressive state,and the scores of memory quotient and total intelligence quotient<79 were regarded as the judgment criteria of memory disorder and intelligence disorder.Logistic regression was used to analyze the independent risk factors of chronic subdural hematoma complicated with behavioral abnormality.Results The incidence of behavior abnormality in patients with chronic subdural hematoma was 73.43%(152/207).According to single factor analysis,there was no significant difference in the incidence of behavior abnormality between the two groups on gender,age and history of coagulation abnormality(all P>0.05);while the differences were statistically significant in history of trauma(χ^2=8.763),history of smoking over 10 years(χ^2=11.491),history of drinking over 10 years(χ^2=14.365),history of cerebrovascular disease(χ^2=11.492),history of hypertension(χ^2=13.057),history of diabetes(χ^2=9.534),history of hyperlipidemia(χ^2=13.274),and disease course over 3 months(χ^2=7.731),hematoma volume over 30 ml(χ^2=12.763),hematoma location(χ^2=21.458),hematoma density(χ^2=8.736),CT midline shift(χ^2=14.572),falx hernia(χ^2=10.396),GCS under 8(χ^2=7.216),and cerebral perfusion defect(χ^2=6.781)between the two groups(all P<0.05).Logistic regression analysis showed that history of trauma(OR=2.164,95%CI=1.083-2.934),history of smoking≥10 years(OR=2.346,95%CI=1.191-2.835),history of drinking≥10 years(OR=2.941,95%CI=1.284-3.157),history of cerebrovascular(OR=3.178,95%CI=1.893-4.597),history of hypertension≥10 years(OR=2.783,95%CI=1.231-2.957),history of diabetes≥10 years(OR=2.841,95%CI=1.309-3.637),history of hyperlipidemia(OR=3.237,95%CI=1.794-5.124),disease course≥3 months(OR=3.957,95%CI=1.997-5.463),volume of hematoma≥30 ml(OR=4.875,95%CI=1.982-5.875),frontotemporal hematoma(OR=4.763,95%CI=1.898-5.968),mixed density hematoma(OR=4.537,95%CI=1.795-5.362),CT midline displacement≥5 mm(OR=4.876,95%CI=1.897-5.985),complicated with falx hernia(OR=4.495,95%CI=1.754-5.247),GCS<8(OR=4.875,95%CI=1.897-5.876),frontotemporal cerebral perfusion defect(OR=4.237,95%CI=1.651-4.896)were independent risk factors for chronic subdural hematoma complicated with behavioral abnormality.Conclusions Chronic subdural hematoma complicated with behavioral abnormality is affected by trauma,smoking,drinking,cerebrovascular disease,hypertension,diabetes,hyperlipidemia,course of disease,volume of hematoma,hematoma location,hematoma density,CT midline displacement,hernia,GCS,cerebral perfusion and other factors.Targeted early intervention may effectively reduce the occurrence of behavioral abnormality in chronic subdural hematoma.