创伤性硬膜外血肿手术患者脑损伤进展的影响因素及其与术前凝血功能的相关性研究

The Influencing Factors of Brain Injury Progress in Patients with Traumatic Extradural Hematoma and Correlation with Coagulation Function before Operation

目的:分析创伤性硬膜外血肿(ATEDH)患者术后脑损伤进展的影响因素,并探讨其与术前凝血功能的相关性。方法:回顾性分析2015年1月-2018年12月联勤保障部队第961医院、武警北京市总队医院收治的62例ATEDH患者的临床资料,术前采用CT评估患者颅内血肿面积,记录患者凝血功能指标,均行开颅血肿清除术。术后采用CT检查,评估局部脑损伤进展,将患者分为进展组与非进展组,分析影响ATEDH患者术后脑损伤进展的危险因素,并探讨其与术前凝血功能的相关性。结果:进展组年龄、性别、合并高血压、术前血小板计数占比与非进展组比较,差异无统计学意义(P>0.05);进展组血肿体积≥40 ml、术前血糖>9.1 mmol/L、术中去骨瓣减压占比高于非进展组,差异有统计学意义(P<0.05);经Logistic回归分析发现,血肿体积≥40 ml、术前血糖>9.1 mmol/L、术中去骨瓣减压是ATEDH患者术后脑损伤进展的危险因素(OR>1,P<0.05);进展组纤维蛋白原(FIB)水平低于非进展组,凝血酶原时间(PT)及活化部分凝血活酶时间(APTT)均长于非进展组,术后格拉斯哥昏迷指数(GCS)评分低于非进展组,差异均有统计学意义(P<0.05);经Spearman相关性分析发现,GCS评分与FIB水平与呈正相关(r>0,P<0.05),与PT、APTT呈负相关(r<0,P<0.05)。结论:ATEDH血肿清除术后可出现脑损伤进展,受多种因素影响,并与患者凝血功能异常有密切关系,应划分具有高危因素的人群,制定针对性治疗方案,以减轻预后风险。

Objective:To analyze the influencing factors of postoperative cerebral injury progression in patients with acute traumatic epidural hematoma(ATEDH),and to investigate its correlation with preoperative coagulation function.Method:The clinical data of 62 patients with ATEDH who admitted in the hospital from January 2015 to December 2018 in the No.961 Hospital of Joint Logistics Support Force and Beijing General Corps Hospital of the People’s Armed Police were retrospectively analyzed.The intracranial hematoma area of patients was evaluated by CT before surgery,the coagulation function indexes of patients were recorded,and the craniotomy evacuation of hematoma was performed.The postoperative CT examination was used to evaluate the progression of local cerebral injury.The patients were divided into the progressive group and the non-progressive group.The risk factors of affecting the progression of postoperative cerebral injury in ATEDH patients were analyzed,and its correlation with preoperative coagulation function was explored.Result:There were no statistical difference in the proportion of age,gender,hypertension,preoperative blood platelet count between progressive group and non-progressive group(P>0.05).The proportion of hematoma volume≥40 ml,preoperative blood glucose>9.1 mmol/L,and intraoperative decompressive craniectomy in progressive group was higher than that in non-progressive group(P<0.05).Logistic regression analysis showed that hematoma volume≥40 ml,preoperative blood glucose>9.1 mmol/L,and intraoperative decompressive craniectomy were risk factors of postoperative cerebral injury progression(OR>1,P<0.05).The level of fibrinogen(FIB)in the progressive group was lower than that in the non-progressive group,the prothrombin time(PT)and activated partial thromboplastin time(APTT)in the progressive group were longer than those in the non-progressive group,and the postoperative Glasgow coma scale(GCS)score in the progressive group was lower than that in the non-progressive group,the differences were statistically significant(P<0.05).Spearman correlation analysis found that GCS score was positively correlated with FIB level(r>0,P<0.05),and negatively correlated with PT and APTT(r<0,P<0.05).Conclusion:Cerebral injury progression after evacuation of hematoma in ATEDH is affected by various factors,and has close relationship with abnormal blood coagulation.Patients with high-risk factors should be divided and given targeted treatment plans to reduce the prognostic risk.