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颅脑损伤去骨瓣减压术后硬膜下积液的临床特点及危险因素分析

王耿焕 沈和平 褚正民 沈建国 张李涛 朱坤灿

王耿焕, 沈和平, 褚正民, 沈建国, 张李涛, 朱坤灿. 颅脑损伤去骨瓣减压术后硬膜下积液的临床特点及危险因素分析[J]. 中华全科医学, 2022, 20(2): 243-245. doi: 10.16766/j.cnki.issn.1674-4152.002323
引用本文: 王耿焕, 沈和平, 褚正民, 沈建国, 张李涛, 朱坤灿. 颅脑损伤去骨瓣减压术后硬膜下积液的临床特点及危险因素分析[J]. 中华全科医学, 2022, 20(2): 243-245. doi: 10.16766/j.cnki.issn.1674-4152.002323
WANG Geng-huan, SHEN He-ping, CHU Zheng-min, SHEN Jian-guo, ZHANG Li-tao, ZHU Kun-can. Clinical features and risk factors of subdural effusion following decompressive craniectomy in patients with traumatic brain injury[J]. Chinese Journal of General Practice, 2022, 20(2): 243-245. doi: 10.16766/j.cnki.issn.1674-4152.002323
Citation: WANG Geng-huan, SHEN He-ping, CHU Zheng-min, SHEN Jian-guo, ZHANG Li-tao, ZHU Kun-can. Clinical features and risk factors of subdural effusion following decompressive craniectomy in patients with traumatic brain injury[J]. Chinese Journal of General Practice, 2022, 20(2): 243-245. doi: 10.16766/j.cnki.issn.1674-4152.002323

颅脑损伤去骨瓣减压术后硬膜下积液的临床特点及危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002323
基金项目: 

浙江省医药卫生科技计划项目 2022KY1257

嘉兴市科技计划项目 2018AD32004

详细信息
    通讯作者:

    沈和平, E-mail: shenege1977@126.com

  • 中图分类号: R651.15

Clinical features and risk factors of subdural effusion following decompressive craniectomy in patients with traumatic brain injury

  • 摘要:   目的  探讨颅脑损伤去骨瓣减压术后硬膜下积液的临床特点,分析其影响因素,为早期进行积极预防和干预提供临床依据。  方法  选择嘉兴学院附属第二医院2010年1月—2019年11月收治的颅脑损伤去骨瓣减压术后患者608例为观察对象,根据术后是否继发硬膜下积液分为硬膜下积液组(120例)和无硬膜下积液组(488例),分析硬膜下积液组的临床特征及影响因素。  结果  608例患者中出现硬膜下积液120例,硬膜下积液发生在手术后4~22(10.3±4.2)d,积液量为12.2~120.8(25.4±10.3)mL,硬膜下积液位于一侧97例,双侧23例,95例保守治疗,25例手术治疗。单因素分析结果显示,积液组与无积液组患者性别、年龄、血肿量、入院格拉斯哥昏迷量表(GCS)评分、中线移位、大骨瓣、双侧开颅、糖尿病差异有统计学意义(均P<0.05)。多因素logistic回归分析显示,年龄、血肿量、入院GCS评分、中线移位、大骨瓣是去骨瓣减压术后硬膜下积液发生的影响因素(均P<0.05)。  结论  颅脑损伤去骨瓣减压术后硬膜下积液发生率高。年龄大、血肿量大、入院GCS评分低、中线移位、大骨瓣是去骨瓣减压术后硬膜下积液发生的危险因素。

     

  • 表  1  2组颅脑损伤患者临床特征比较

    组别 例数 性别(男/女, 例) 年龄(x±s, 岁) 血肿量(x±s, mL) 入院GCS评分(x±s, 分) 中线移位[例(%)] 大骨瓣[例(%)] 双侧开颅[例(%)] 脑室出血[例(%)]
    硬膜下积液组 120 101/9 62.2±14.2 52.2±8.6 7.5±1.2 111(92.5) 112(93.3) 15(12.5) 20(16.7)
    无硬膜下积液组 488 349/139 52.5±16.7 45.6±6.8 8.6±1.4 410(84.0) 408(83.6) 31(6.3) 53(10.9)
    统计量 19.866a 5.862b 9.010b 25.200b 5.653a 5.382a 5.205a 3.073a
    P < 0.001 < 0.001 < 0.001 < 0.001 0.017 0.020 0.023 0.080
    组别 例数 蛛网膜下腔出血[例(%)] 合并损伤[例(%)] 颅内感染[例(%)] 高血压[例(%)] 糖尿病[例(%)] 脑梗死[例(%)] 早期癫痫[例(%)]
    硬膜下积液组 120 115(95.8) 69(57.5) 7(5.8) 24(20.0) 18(15.0) 10(8.3) 9(7.5)
    无硬膜下积液组 488 459(94.1) 241(49.4) 24(4.9) 78(16.0) 42(8.6) 29(5.9) 26(5.3)
    统计量 0.575a 2.538a 0.159a 1.113a 4.426a 0.917a 0.838a
    P 0.448 0.111 0.690 0.292 0.035 0.338 0.360
    注:aχ2值,bt值。
    下载: 导出CSV

    表  2  颅脑损伤患者继发硬膜下积液的影响因素分析

    项目 B SE Wald χ2 P OR 95% CI
    年龄 0.969 0.446 4.728 0.030 2.635 1.100~6.310
    血肿量 1.651 0.836 3.897 0.048 5.208 1.256~15.235
    入院GCS评分 1.043 0.435 5.734 0.017 2.837 1.208~6.662
    中线移位 0.820 0.356 5.310 0.021 2.271 1.130~4.564
    大骨瓣 1.003 0.423 5.623 0.018 2.725 1.190~6.250
    下载: 导出CSV
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出版历程
  • 收稿日期:  2021-03-10
  • 网络出版日期:  2022-03-04

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