急性硬膜下血肿术后继发脑梗死的危险因素分析

Risk factors of postoperative cerebral infarction after acute subdural hematoma surgery

目的 探讨急性硬膜下血肿(ASDH)术后继发脑梗死的相关危险因素。方法 回顾性分析95例急性硬膜下血肿行开颅血肿清除术患者的临床资料。对术后继发脑梗死的危险因素,性别、年龄、术前格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分、术前时间、双侧瞳孔变化、基底池形态、脑疝、血肿体积、血肿厚度、中线移位、围手术期血压11个相关指标,行单因素分析和多因素Logistic回归分析。结果 29例患者术后继发脑梗死,发生率为30.5%。对相关指标行χ 2检验显示,术前GCS评分、术前时间、脑疝、术前瞳孔变化、中线移位、基底池形态、血肿体积、围手术期血压8个指标有统计学意义(均P <0.05);而性别、年龄、血肿厚度无统计学意义。将上述8个指标行Logistic回归分析,结果显示术前基底池形态(P=0.005,OR=4.606)和GCS评分(P=0.01,OR=3.026)有统计学意义。结论 术前GCS评分、双侧瞳孔改变、基底池形态、血肿大小、中线移位、脑疝、术前时间及围手术期血压与急性硬膜下血肿术后继发脑梗死有关;其中术前GCS评分和基底池形态是术后继发脑梗死的独立危险因素。

Objective To investigate the risk factors of secondary cerebral infarction after acute subdural hematoma by collecting and analyzing clinical cases of acute subdural hematoma(ASDH).Methods The total of 95 patients with ASDH underwent craniotomy evacuation of hematoma were analyzed retrospectively.The potential risk factors of PCI were analyzed by single-factor analysis and Logistic regression analysis.Results 29 patients had secondary cerebral infarction.The incidence rate of secondary cerebral infarction was 30.5%.Univariate chi-squares test was performed on 11 related indicators,such as gender,age,preoperative GCS,preoperative time,bilateral pupillary changes,basal cistern changes,cerebral hernia,ASDH volume,hematoma thickness,midline shift and perioperative blood pressure.Preoperative GCS,preoperative time,bilateral pupillary changes,basal cistern changes,cerebral hernia,ASDH volume,midline shift,and perioperative blood pressure were related to postoperative secondary cerebral infarction( alP<0.05 ).There was no statistical significance between gender,age and hematoma thickness.Multivariate Logistic regression analysis of the above 8 univariate factors showed that the morphology of CT basal cistern( P=0.005,Odds Ratio,OR=4.606) and preoperative GCS score( P=0.01,OR=3.026) had statistical value.Conclusions Preoperative GCS score,preoperative time,bilateral pupillary changes,basal cistern changes,cerebral hernia,ASDH volume,midline shift,and perioperative blood pressure are associated with postoperative secondary cerebral infarction after ASDH.Preoperative GCS score and basal cistern changes are independent risk factors for postoperative secondary cerebral infarction.