颅脑损伤后急性硬膜下血肿预后相关因素的探讨

Discussion on the predictors of acute subdural hematoma following traumatic brain injury

目的探讨影响急性硬膜下血肿(ASDH)预后的相关因素。方法回顾性总结我院2000年3月～2009年3月256例ASDH手术治疗患者术前及术后1个月临床资料,通过Logistic回归分析评价影响患者预后的相关危险因素。结果术后神经功能恢复良好42.2%,主要影响因素为:年龄、术前瞳孔变化、术前格拉斯哥评分(GCS)、术中脑肿胀;死亡率39.8%,主要影响因素为:术前瞳孔变化、术前GCS评分、术中脑肿胀、术前低血压和低氧血症。而术前头颅CT中线偏移程度、血肿量及血肿厚度、伤后手术时间与术后预后有关,但不是主要影响因素。结论急性硬膜下血肿患者年龄<40岁、术前GCS评分较高、术前瞳孔光反射存在、术前无低血压和低氧血症、无脑肿胀,患者功能恢复相对较好。

Objective To explore factors associated with prognosis in patients with acute subddural hematoma （ ASDH ）. Methods The preoperative and postoperative data of 256 patients in our hospital who underwent surgi- cal intervention for traumatic ASDH were reviewed. The related factors of prognosis were analyzed by using multiva- riate logistic regression analysis. Results Functional recovery was achieved in 42.2% of patients and the overall mortality was 39.8%. Age, pupillary abnormality, preoperative GCS score, and intraoperative acute brain swelling （ ABS } were independent predictors for functional recovery. And preoperative pupillary abnormality, GCS score, and intraoperative ABS were independent predictors for mortality. Midline shift thickness, volume of hematoma,operation time following injury showed no independent association with functional recovery, although these variables were cor- related with functional recovery in univariate analyses. Conclusion Functional recovery is more likely to be a- chieved in patients who are under 40 years old, and have preoperative reactive pupils, higher GCS score and the absence of ABS during surgery.