创伤性急性硬膜下血肿非手术治疗后慢性硬膜下血肿进展的危险因素分析

Risk Factors of Chronic Subdural Hematoma after Non-operative Management of Traumatic Acute Subdural Hematoma

目的分析创伤性急性硬膜下血肿(acute subdural hematoma,aSDH)非手术治疗后进展为慢性硬膜下血肿(chronic subdural hematoma,cSDH)的危险因素,确立其有潜在应用价值的临床特征。方法本研究收集了2016年1月~2021年1月的201例aSDH患者。根据非手术治疗aSDH是否进展为cSDH将患者分为cSDH进展组(n=21)和非cSDH进展组(n=180)。分析两组患者一般临床信息、颅脑CT表现及实验室相关检查等。采用单因素和多因素分析确定独立的危险因素。结果cSDH进展组患者平均年龄大于非cSDH进展组(69.00±9.98岁vs 60.44±8.74岁,P<0.001),两组患者性别比较,差异无统计学意义。cSDH进展组均匀密度的Hounsfield单位(Hounsfield units,HU)和混杂密度患者远高于非cSDH进展组,cSDH进展组的中线偏移和血肿厚度显著大于非cSDH进展组(2.85±1.08mm vs 0.77±0.80mm;6.16±1.22mm vs 3.60±1.06mm,P<0.001),两组纵向比及血肿体积比较,差异无统计学意义。结论本研究确定了aSDH进展为cSDH有关的独立危险因素:血肿厚度较大、中线偏移及血肿密度混杂。因此,初始脑CT发现有aSDH较厚、aSDH密度混杂的患者需要更严密观察,以早期治疗干预。

Objective To analyze the risk factors for progression to chronic subdural hematoma(cSDH)after nonsurgical treatment of traumatic acute SDH(aSDH)and establish its clinical characteristics with potential applications.Methods This study collected 201 patients with aSDH from January 2016 to January 2021.Patients were divided into cSDH progression group(n=21)and non-cSDH progression group(n=180)according to whether or not they developed into cSDH after nonsurgically treated aSDH.The general clinical information,cranial CT findings and related laboratory tests of the patients in the two groups were analyzed.Univariate and multivariate analyses were used to identify independent risk factors.Results The mean age of patients was older in the cSDH progression group than in the non-cSDH progression group(69.00±9.98 years vs 60.44±8.74 years,P<0.001).There was no statistically significant difference in gender.Hounsfield units of uniform density and mixed density patients were higher in the cSDH progression group than in the non-cSDH progression group.Midline shift and hematoma thickness were significantly greater in the cSDH progression group than in the non-cSDH progression group(2.85±1.08mm vs 0.77±0.80mm;6.16±1.22mm vs 3.60±1.06mm,P<0.001),but the longitudinal ratio and hematoma volume were not significantly different between the two groups.Conclusion The independent risk factors related to the progression of aSDH to cSDH were determined:large hematoma thickness,midline deviation and mixed hematoma density.Therefore,patients with initial brain CT findings of thicker aSDH,mixed density,and higher homogeneous density may need close observation forearlytherapeutic intervention.