钻孔引流术治疗硬膜下血肿后相关并发症的成因及防治策略分析

Analysis of the Causes and Prevention Strategies of Related Complications after Drilling and Drainage in the Treatment of Subdural Hematoma

目的钻孔引流术治疗硬膜下血肿后相关并发症的成因及防治策略分析。方法选择2017年2月—2021年9月盐城市第三人民医院收治的硬膜下血肿患者78例,对其临床资料进行回顾性分析。根据是否发生并发症,分为并发症组(12例)和未发生并发症组(66例)。经多因素Logistic回归分析术后并发症的独立危险因素。结果78例患者中,术后出现并发症共12例,未出现并发症66例。术后出现硬膜下积液4例(5.13%)(术侧3例,对侧1例),术后癫痫3例(3.85%),术后慢性硬膜下血肿复发4例(5.13%),非钻孔处硬膜外血肿1例(1.28%)。经单因素分析,两组在颅内压降低(91.67%vs 4.54%)、误将引流管穿入脑实质(100.00%vs 6.06%)、对硬膜上出血点处理不佳(91.67%vs 4.54%)、脑萎缩(100.00%vs 48.48%)、插入导管不恰当(83.33%vs 46.97%)、血肿包膜刺激皮层(91.67%vs 43.94%)、蛛网膜受损(83.33%vs 45.45%)方面对比,差异有统计学意义(χ^(2)=46.582、49.344、46.582、10.958、5.384、9.258、5.831,P<0.05);两组在性别、年龄、血肿类型方面对比,差异无统计学意义(χ^(2)=0.114、0.009、0.189,P>0.05)。经多因素Logistic回归分析,颅内压降低、误将引流管穿入脑实质、对硬膜上出血点处理不佳、脑萎缩、插入导管不恰当、血肿包膜刺激皮层、蛛网膜受损均为导致术后并发症的独立危险因素(P<0.05)。结论硬膜下积液、术后癫痫、血肿复发等均为钻孔引流术治疗硬膜下血肿后常见并发症,及时明确成因,并采取针对性防治措施,可有效降低术后并发症发生率,改善预后。

Objective To analyze the causes and prevention strategies of related complications after drilling and drainage in the treatment of subdural hematoma. Methods From February 2017 to September 2021, 78 patients with subdural hematoma admitted to Yancheng Third People’s Hospital were selected for retrospective analysis of their clinical data. According to whether there were complications, they were divided into complication group(12 cases) and non complication group(66 cases). The independent risk factors of postoperative complications were analyzed by multivariate logistic regression. Results Among 78 patients, 12 patients had postoperative complications, and 66 patients had no complications. Postoperative subdural effusion occurred in 4 cases(5.13%)(3 cases on the operative side, 1 case on the opposite side), postoperative epilepsy in 3 cases(3.85%), postoperative recurrence of chronic subdural hematoma in 4 cases(5.13%), and epidural hematoma at non drilling site in 1 case(1.28%). By single factor analysis, the two groups were compared in terms of decreased intracranial pressure(91.67% vs4.54%), misplaced drainage tube into cerebral parenchyma(100.00% vs 6.06%), poor treatment of supradural hemorrhage(91.67% vs4.54%), brain atrophy(100.00% vs 48.48%), inappropriate catheter insertion(83.33% vs 46.97%), hematoma capsule stimulating cortex(91.67% vs 43.94%), and arachnoid damage(83.33% vs 45.45%), the difference was statistically significant(χ^(2)=46.582, 49.344, 46.582,10.958, 5.384, 9.258, 5.831, P<0.05). There was no statistically significant difference between the two groups in terms of gender, age and type of hematoma(χ^(2)=0.114, 0.009, 0.189, P>0.05). Multivariate logistic regression analysis showed that decreased intracranial pressure, misplaced drainage tube into cerebral parenchyma, poor management of supradural hemorrhage, brain atrophy, inappropriate catheter insertion,hematoma capsule stimulating cortex, and arachnoid damage were all independent risk factors for postoperative complications(P<0.05). Conclusion Subdural effusion, postoperative epilepsy, and hematoma recurrence are common complications after drilling and drainage for subdural hematoma. Identifying the causes in time and taking targeted preventive measures can effectively reduce the incidence of postoperative complications and improve the prognosis.