慢性硬膜下血肿患者术后复发的相关危险因素及其预防措施

Risk factors and preventive measures for postoperative recurrence of chronic subdural hematoma

目的探讨慢性硬膜下血肿患者术后复发的相关危险因素及其预防措施。方法回顾性分析2016年2月至2020年4月间在汕头市潮阳区大峰医院行手术治疗的284例慢性硬膜下血肿患者的临床资料,按照术后是否复发分为术后复发组(19例)和术后未复发组(265)例,采用多因素Logistic回归方法分析影响慢性硬膜下血肿患者术后复发的相关危险因素。结果术后复发组术前脑中线移位>10 mm、术前CT高密度和混杂密度、术后残留大量积气、术前血肿最大层面厚度>20 mm、术后引流量>200 mL方面水平均高于未复发组(P<0.05);两组合并糖尿病、性别、合并高血压、年龄、出血倾向、术前血肿最大层面厚度比较无统计学差异(P>0.05);多因素Logistic回归分析显示,术前脑中线移位>10 mm、术前CT高密度和混杂密度、术后残留大量积气、术前血肿最大层面厚度>20 mm、术后引流量>200 mL是慢性硬膜下血肿患者术后复发的高危因素(OR≥1且P<0.05)。结论慢性硬膜下血肿患者术后复发是多种因素共同作用的结果,临床需针对各危险因素制定相应的防治措施,以降低术后复发率,改善预后。

Objective To investigate the risk factors and preventive measures of postoperative recurrence of chronic subdural hematoma.Methods The clinical data of 284 patients with chronic subdural hematoma who underwent surgical treatment in Dofeng Hospital, Chaoyang District, Shantou city from February 2016 to April 2020 was retrospectively analyzed.They were divided into postoperative recurrence group(19 cases) and non-recurrence group(265 cases) according to whether postoperative recurrence occurred.Multivariate Logistic regression method was used to analyze the risk factors affecting postoperative recurrence of chronic subdural hematoma.Results The levels of preoperative brain line displacement >10 mm, preoperative CT high density and mixed density, postoperative residual gas, preoperative maximum thickness of hematoma >20 mm and postoperative drainage volume >200 mL in the recurrence group were higher than those in the non-recurrence group(P<0.05).There were no significant differences in diabetes mellitus, gender, hypertension, age, bleeding tendency and preoperative maximum thickness of a hematoma between the two groups(P>0.05).Multivariate Logistic regression analysis showed that preoperative brain linear displacement >10 mm, preoperative CT high density and mixed density, postoperative residual gas, preoperative maximum thickness of hematoma>20 mm, postoperative drainage volume >200 mL were high-risk factors for postoperative recurrence of chronic subdural hematoma(OR≥1 and P<0.05).Conclusion Postoperative recurrence of chronic subdural hematoma result from multiple factors.Clinical prevention and treatment measures should be formulated according to various risk factors to reduce postoperative recurrence rate and improve prognosis.