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 Epidural Hematoma Surgery

目的探讨硬膜外血肿患者实施手术后发生脑水肿的相关危险因素。方法将50例急性硬膜外血肿患者按照手术后有无脑水肿分为水肿组(n=24例)和正常组(n=26例)。对两组患者进行格拉斯哥昏迷评分(GCS评分),记录两组患者的年龄、性别、瞳孔大小、脑中线位移情况、血肿量、有无基础疾病、血压有无升高等可能的相关危险因素,对这些患者的临床资料中可能导致脑水肿的危险因素进行Logistic回归分析。结果 两组患者年龄、性别、基础疾病比较差异无统计学意义,但术前GCS评分、瞳孔散大、血肿量、脑中线位移程度、血压有无升高、手术是否拖延比较差异有统计学意义。经Logistic回归分析统计瞳孔散大、血肿量大、血压升高、手术拖延是导致脑水肿的危险因素。结论 经硬膜外血肿手术后的患者极易发生脑水肿,为防止脑水肿的发生,应仔细观察患者有无血压升高、瞳孔有无散大并尽早手术,这样才能减轻手术后脑水肿的发生,有效改善患者的预后。

Objective To explore the risk factors of brain edema in patients after epidural hematoma surgery. Methods Fifty patients with acute epidural hematoma were divided into two groups in accordance with brain edema after surgery：edema group （24 cases） and normal group （26 cases）. Glasgow coma score of two groups of patients （GCS score） were done and age,sex,pupil size,brain midline shift and hematoma volume, underlying diseases history, increase of blood pressure and other related risky factors of the two groups of patients were recorded, then risk factors that may result in cerebral edema according to clinical data of the patients by using ＂logistic regression analysis. Results There was no statistical significance by comparing two groups of patients＇ age,sex,underlying diseases,but differences of preoperative GCS score, mydriasis, hematoma volume,extent of brain midline shift,increase of blood pressure showed statistical significance if surgery was delayed. Logistic regression statistics proved that mydriasis,high hematoma volume, blood pressure increase and operation delay were the risk factors of cerebral edema. Conclusion It＇s quite possible for patients with epidural hematomas to suffer from brain edema after surgery. To prevent the occurrence of cerebral edema,we should carefully observe the patients＇ blood pressure increase,the pupil enlargement and treat them by surgery as soon as possible,in order to reduce the prob- ability of brain edema and effectively improve the prognosis of patients.