硬膜外血肿手术后脑水肿临床多因素分析

Clinical analysis of multiple factors responsible for brain edema after acute evacuation of epidural hematomas

目的探讨急性硬膜外血肿患者术后脑水肿发生的机制及其影响因素和术中去骨瓣减压的指征。方法将150例急性硬膜外血肿患者分为水肿组和无水肿组两组,根据患者GCS评分,瞳孔大小,血肿量,CT或MR检查脑中线移位程度,结合手术时间、中线及周围池改变、血肿部位、年龄及是否有原发昏迷等资料进行统计学分析。结果两组在术前GCS评分,瞳孔进行性散大,血肿量增大,脑中线结构移位程度加重,手术拖延等方面均有显著性差异(P＜0．01)而在血肿部位、年龄、是否有原发昏迷等方面未见显著差异(P＞0．05)。结论急性硬膜外血肿术后脑水肿主要是急性脑受压造成的；脑受压程度越重、时间越长,术后脑水肿越严重；早期手术是避免或减轻术后脑水肿的有效措施,对术后发生较大范围的脑水肿病例应及时去骨瓣减压。

Objective To explore the mechanism of brain edema and its influential factors after the treatment in acute extradural hematoma and the indications of bony decompression. Methods 150 cases of acute epidural hemotoma were divided into edema and non-edema groups. Statistical analysis was based on eight factors of GCS, diameter of pupils, amount of hematoma, the moved degree of brain midline in CT or MRI, age, and original coma. Results The two groups showed much significant difference in the five influential factors of preoperative GCS, progressive expansion of pupils, the moving degree of brain midline and delayed operation （P〈0.01）, while no significance was found between the groups in such factors of surgical hematoma, age, and original coma. Conclusion Brain edema of acute epidural hemotoma results from acute cerebral oppression. The more serious and longer the cerebral oppression is, the more severe brain edema after operation. Early operation can avoid and alleviate the edema. Bony decompression should be performed in time for the patients with large brain edema.