慢性硬膜下血肿行神经内镜术后血肿复发及其危险因素分析

Analysis of Hematoma Recurrence and Its Risk Factors after Neuroendoscopy of Chronic Subdural Hematoma

目的:探究慢性硬膜下血肿患者开展神经内镜术后血肿复发情况及危险因素,为改善患者预后提供参考。方法:回顾性选择2018年9月至2022年1月在开封市中心医院被确诊为慢性硬膜下血肿并接受神经内镜术治疗的190例患者为研究对象,按照对其随访12个月结果的差异将其区分为复发组(21例)和无复发组(169例),采用logistic回归模型分析患者血肿复发的危险因素。结果:190例患者中有21例出现了血肿复发,复发率为11.05%,无复发169例;单因素分析结果显示,两组患者在术后残余气体量、凝血功能是否异常、术后是否服用他汀类药物、血肿侧别、血肿密度、术前血肿厚度方面比较,差异均具有统计学意义(P<0.05);多因素logistic回归分析显示,有凝血功能异常、术后未服用他汀类药物、高密度血肿、双侧血肿、术前血肿厚度>25 mm是导致慢性硬膜下血肿行神经内镜术后血肿复发的独立危险因素(P<0.05)。结论:慢性硬膜下血肿行神经内镜术后血肿复发率较高,其中凝血功能异常、术后未服用他汀类药物、高密度血肿、双侧血肿、术前血肿厚度>25 mm是导致复发的独立危险因素,建议对存在上述危险因素的患者积极开展随访干预,以改善患者预后。

Objective To explore hematoma recurrence and risk factors after neuroendoscopy in patients with chronic subdural hematoma,to provide reference for improving patient prognosis.Methods A retrospective study was conducted on 190 patients diagnosed with chronic subdural hematoma in Kaifeng Central Hospital from September 2018 to January 2022 who underwent neuroendoscopic treatment.They were divided into a recurrent group(21 cases)and a non-recurrent group(169 cases)based on the difference in their follow-up results for 12 months,using a multivariate logistic regression model to analyze the risk factors for hematoma recurrence in patients undergoing neuroendoscopic treatment for chronic subdural hematoma.Results Hematoma recurred in 21 of 190 patients,with a recurrence rate of 11.05% and no recurrence in 169 patients.The results of univariate analysis showed that there were statistically significant differences between the two groups in postoperative residual gas volume,abnormal coagulation function,postoperative statin use,hematoma side,hematoma density and preoperative hematoma thickness(P<0.05).Multivariate logistic regression analysis showed that abnormal coagulation function,no postoperative statin therapy,high-density hematoma,bilateral hematoma,and preoperative hematoma thickness>25 mm were independent risk factors for hematoma recurrence after neuroendoscopy of chronic subdural hematoma(P<0.05).Conclusion The recurrence rate of chronic subdural hematoma after neuroendoscopy is relatively high,among which abnormal coagulation function,no postoperative statin,high-density hematoma,bilateral hematoma,and preoperative hematoma thickness>25 mm are independent risk factors for recurrence.It is recommended to actively carry out follow-up intervention for patients with these risk factors to improve the prognosis of patients.