颅脑肿瘤术后远隔部位急性硬膜外血肿相关因素分析

Postoperative acute epidural hematoma remote from the site of craniotomy: analysis on the related factors

目的探讨颅脑肿瘤手术后并发远隔部位急性硬膜外血肿的相关风险因素。方法回顾性分析我科近5年14例颅脑肿瘤术后远隔部位硬膜外血肿发生的特点,按1∶4随机选取未发生远隔部位硬膜外血肿的颅脑肿瘤手术病例作为对照,对性别、年龄、肿瘤部位、肿瘤大小、有无脑积水、有无脑萎缩、术前血糖水平、有无高血压、手术体位、病理分型、甘露醇应用及手术时间等12个相关指标进行单因素分析,对有意义的指标再行Logistic多因素回归分析。结果单因素分析显示:年龄、肿瘤大小、有无脑积水、有无脑萎缩、手术体位和使用甘露醇等6个指标与颅脑肿瘤术后并发远隔部位急性硬膜外血肿具有相关性(P<0.05),Logistic多因素回归分析显示:年龄、肿瘤大小、有无脑积水、有无脑萎缩可能为导致颅脑肿瘤术后并发远隔部位急性硬膜外血肿的独立因素(P<0.05)。结论颅脑肿瘤术后远隔部位急性硬膜外血肿形成机制为多种原因导致的颅内压及脑脊液动力学改变致硬脑膜与颅骨剥离,但临床工作中更应注意肿瘤大小、有无脑积水、有无脑萎缩这几个因素。

Objective To investigate the related risk factors of postoperative acute epidural hematon^a remote from the site of craniotomy. Methods The characteristics of 14 cases of postoperative acute epidural hematoma remote from the site of craniotomy in our department over the past five years were analyzed. Cases without remote postoperative epidural hematoma were randomly selected as a control group with a ratio of 1： 4. Univariate analysis was carried out for 12 indices, including gender, age, location of the tumor, tumor size, with or without hydrocephalus, brain atrophy and hypertension, preoperative glucose levels, operative position, pathological type, application of mannitol and operative time. Then the significant indices were selected for Logistic multivariate regression analysis. Results The results of univariate analysis demonstrated six indices including age, tumor size, with or without hydrocephalus, brain atrophy, operative position and application of mannitol were correlated with postoperative remote epidural hematoma （P 〈 0. 05）. The results of Logistic multivariate regression analysis demonstrated that age, tumor size, with or without hydrocephalus and brain atrophy were independent factors for postoperative remote epidural hematotrka （P 〈 0. 05）. Conclusion The formation mechanism of postoperative remote epidural hematoma was the dural and skull stripping caused by changes of intracranial pressure and cerebrespinal fluid dynamics, which were induced by a variety of reasons, such as tumor size, hydrocephalus and brain atrophy. Therefore, these factors should be paid more attention to in the clinical pratices.