颅脑损伤患者术后迟发性颅内血肿的影响因素研究

Influencing Factors of Delayed Traumatic Intracranial Hematoma in Postoperative Traumatic Brain Injury Patients

目的探究颅脑损伤患者术后迟发性颅内血肿的影响因素。方法选取2010年6月—2015年6月内江市第二人民医院收治的颅脑损伤患者264例,均行急诊颅内血肿清除术,其中37例患者术后发生迟发性颅内血肿(观察组),227例未发生迟发性颅内血肿(对照组)。自制EXCEL表格收集患者临床资料,内容包括性别、年龄、受伤机制(加速性损伤和减速性损伤)、首次CT检查时间、颅脑损伤程度、开放性损伤情况、脑挫裂伤情况、颅骨骨折情况、血肿位置(硬膜外血肿、硬膜下血肿、脑内血肿)、血肿量、血压(收缩压和舒张压)、血糖、凝血指标〔凝血酶原时间(PT)、凝血酶时间(TT)、活化部分凝血酶时间(APTT)、纤维蛋白原(FIB)、血小板计数(PLT)〕、入院至手术时间及去骨瓣减压术情况,采用非条件多因素logistic回归分析筛选颅脑损伤患者术后迟发性颅内血肿的影响因素。结果单因素分析结果显示,两组患者性别、年龄、受伤机制、首次CT检查时间、开放性损伤发生率、脑内血肿发生率、血肿量、收缩压及PT、FIB、PLT比较,差异无统计学意义(P>0.05);观察组患者颅脑损伤程度重于对照组,脑挫裂伤、颅骨骨折、硬膜外血肿、硬膜下血肿发生率及舒张压、血糖、行去骨瓣减压术者所占比例高于对照组,TT、APTT长于对照组,入院至手术时间短于对照组(P<0.05)。非条件多因素logistic回归分析结果显示,重度颅脑损伤〔OR=3.757,95%CI(2.475,5.797)〕、脑挫裂伤〔OR=2.874,95%CI(1.574,4.264)〕、颅骨骨折〔OR=1.864,95%CI(1.162,3.465)〕及TT延长〔OR=1.964,95%CI(1.254,4.038)〕是颅脑损伤患者术后迟发性颅内血肿的独立危险因素(P<0.05)。结论重度颅脑损伤、脑挫裂伤、颅骨骨折及TT延长是颅脑损伤患者术后迟发性颅内血肿的危险因素。

Objective To analyze the influencing factors of delayed traumatic intracranial hematoma in postoperative traumatic brain injury patients. Methods A total of 264 traumatic brain injury patients were selected in the Second People’ s Hospital of Neijiang from June 2010 to June 2015,all of them received emergency evacuation of intracranial hematoma,thereinto37 patients complicated with delayed traumatic intracranial hematoma were served as observation group,other 227 patients did not complicated with delayed traumatic intracranial hematoma were served as control group. Self- made EXCEL table was used to collect related clinical data,including gender,age,injury mechanism（ including accelerated injury and decelerated injury）,the first examination time of CT, severity of traumatic brain injury, incidence of patulous injury, incidence of contusion and laceration of brain, incidence of skull fracture, hematoma locations（ including epidural hematoma, subdural hematoma and intracerebral hematoma）, hematoma volume, blood pressure（ including SBP and DBP）, FBG, coagulation markers（ including PT,TT,APTT,FIB and PLT）,duration between admission and operation,and the proportion of decompressive craniectomy,unconditional multivariate logistic regression analysis was used to analyze the influencing factors of delayed traumatic intracranial hematoma in postoperative traumatic brain injury patients. Results Univariate analysis showed that,no statistically significant differences of gender, age, injury mechanism, the first examination time of CT, incidence of patulous injury,incidence of intracerebral hematoma,hematoma volume,SBP,PT,FIB or PLT was found between the two groups; severity of traumatic brain injury of observation group was statistically significantly more severe than that of control group, incidence of contusion and laceration of brain, of skull fracture, of epidural hematoma, of subdural hematoma, DBP, FBG andthe proportion of decompressive craniectomy of observation group were statistically significantly higher than those of control group,TT and APTT of observation group were statistically significantly longer than those of control group,duration between admission and operation of observation group was statistically significantly shorter than that of control group（ P 〈 0. 05）. Unconditional multivariate logistic regression analysis showed that,severe traumatic brain injury 〔OR = 3. 757,95% CI（ 2. 475,5. 797） 〕,contusion and laceration of brain 〔OR = 2. 874,95% CI（ 1. 574,4. 264） 〕,skull fracture 〔OR = 1. 864,95% CI（ 1. 162,3. 465） 〕and TT 〔OR = 1. 964,95% CI（ 1. 254,4. 038） 〕 were independent risk factors of delayed traumatic intracranial hematoma in postoperative traumatic brain injury patients（ P 〈 0. 05）. Conclusion Severe traumatic brain injury,contusion and laceration of brain, skull fracture and TT are independent risk factors of delayed traumatic intracranial hematoma in postoperative traumatic brain injury patients.