改良颅骨钻孔引流治疗慢性硬膜下血肿术后肺部感染及预后不良相关因素分析

Analysis of the factors related to pulmonary infection and poor prognosis after modified burr-hole drainage for chronic subdural hematoma

目的探讨改良颅骨钻孔血肿引流术治疗慢性硬膜下血肿的安全性和有效性,分析术后病人肺部感染及预后不良的相关因素。方法回顾性分析202例采用改良颅骨钻孔引流术治疗慢性硬膜下血肿病人的临床及影像学资料。结果住院期间发生术后并发症17例(8.4%),其中肺部感染12例,尿路感染2例,切口感染2例,急性无症状脑内点状出血1例。入院时GCS评分(<15分)是住院期间发生术后肺部感染的危险预测因素(P=0.003,OR=9.368)。术后3个月随访197例(97.5%),预后良好177例(89.8%),预后不良20例(10.2%)。血肿复发6例(3.0%),死亡2例(1.0%)。年龄≥75岁(P=0.007,OR=6.264)及出院时mRS评分≥3分(P<0.001,OR=19.029)是病人预后不良的预测因素。结论改良颅骨钻孔引流术是一种安全、有效的慢性硬膜下血肿手术方式。术前病人GCS评分低(<15分)是住院期间发生术后肺部感染的危险预测因素。年龄大(≥75岁)及出院时mR S评分高(mRS≥3分)是病人预后不良的预测因素。

Objective To explore the safety and efficacy of modified burr-hole drainage for chronic subdural hematoma, and analyze the factors related to pulmonary infection and poor prognosis after the surgery. Methods Clinical and imaging data of 202 patients with chronic subdural hematoma undergoing modified burr-hole drainage were analyzed retrospectively. Results The postoperative complications occurred in 17 patients（8.4%）, including 12 pulmonary infections, 2 urinary tract infections, 2 incision infections and 1 punctate intracerebral hemorrhages. Admission GCS score less than 15 points was an independent risk factor for postoperative pulmonary infection based on the multiple-factor analysis（P = 0.003, OR = 9.368）. During a follow-up period of 3 months in 197 patients（97.5%）, good prognosis was achieved in 177 patients（89.8%） and poor prognosis in 20（10.2%）. Hematoma recurrence was seen in 6 patients（3.0%） and 2 patients（1.0%） died. The age more than or equal to 75 years（P = 0.007, OR = 6.264） and discharge mRS score more than or equal to 3 points（P〈 0.001, OR = 19.029） were the independent risk factors for poor prognosis. Conclusions Modified burr-hole drainage is a safe and effective procedure for chronic subdural hematoma. Admission GCS less than 15 points is an independent risk factor for postoperative pulmonary infection. The age more than or equal to 75 years and discharge mRS score more than or equal to 3 points are the independent risk factors for poor prognosis.