中国全科医学
中國全科醫學
중국전과의학
CHINESE GENERAL PRACTICE
2014年
33期
3997-3999
,共3页
沈佳%杨渭林%裘申忠%毛伟%殷怀明
瀋佳%楊渭林%裘申忠%毛偉%慇懷明
침가%양위림%구신충%모위%은부명
颅脑损伤%危险因素%开颅手术%迟发性颅内血肿
顱腦損傷%危險因素%開顱手術%遲髮性顱內血腫
로뇌손상%위험인소%개로수술%지발성로내혈종
Craniocerebral trauma%Risk factors%Craniotomy%Delayed intracranial hematoma
目的：探讨重型颅脑损伤患者行开颅手术后发生迟发性颅内血肿的危险因素，以期能够改善患者预后质量。方法选取2010年3月-2014年3月富阳市人民医院收治的行开颅手术治疗的重型颅脑损伤患者102例，依据患者术后是否发生迟发性颅内血肿将其分为迟发组和非迟发组，记录两组患者临床资料，包括性别、年龄、发病至手术时间、颅骨骨折、蛛网膜下腔出血、Babinski 征阳性、基底池受压、血浆凝血酶原时间、活化部分凝血活酶时间、血浆凝血酶时间、格拉斯哥昏迷量表（GCS）评分、收缩压、舒张压、血小板计数、纤维蛋白原、血肿量等。采用多因素 Logistic 回归分析探讨影响患者行开颅手术后发生迟发性颅内血肿的危险因素。结果依据患者术后是否发生迟发性颅内血肿将其分为迟发组41例和非迟发祖61例。两组性别、年龄、蛛网膜下腔出血发生率、血浆凝血酶原时间、收缩压、血小板计数、血肿量比较，差异均无统计学意义（P >0.05）；两组发病至手术时间、颅骨骨折发生率、Babins-ki 征阳性发生率、基底池受压发生率、活化部分凝血活酶时间、血浆凝血酶时间、GCS 评分、舒张压、纤维蛋白原水平比较，差异均有统计学意义（P <0.05）。进一步行多因素 Logistic 回归分析结果显示，发病至手术时间、颅骨骨折、Babinski 征阳性、血浆凝血酶时间是重型颅脑损伤患者行开颅手术后发生迟发性颅内血肿的独立影响因素（P <0.05）。结论对伴随颅骨骨折、Babinski 征阳性、血浆凝血酶时间延长以及发病至手术时间较早等出现发生迟发性颅内血肿的独立危险因素的重型颅脑损伤患者应加强监护并给予早期预防治疗，降低迟发性颅内血肿发生风险。
目的：探討重型顱腦損傷患者行開顱手術後髮生遲髮性顱內血腫的危險因素，以期能夠改善患者預後質量。方法選取2010年3月-2014年3月富暘市人民醫院收治的行開顱手術治療的重型顱腦損傷患者102例，依據患者術後是否髮生遲髮性顱內血腫將其分為遲髮組和非遲髮組，記錄兩組患者臨床資料，包括性彆、年齡、髮病至手術時間、顱骨骨摺、蛛網膜下腔齣血、Babinski 徵暘性、基底池受壓、血漿凝血酶原時間、活化部分凝血活酶時間、血漿凝血酶時間、格拉斯哥昏迷量錶（GCS）評分、收縮壓、舒張壓、血小闆計數、纖維蛋白原、血腫量等。採用多因素 Logistic 迴歸分析探討影響患者行開顱手術後髮生遲髮性顱內血腫的危險因素。結果依據患者術後是否髮生遲髮性顱內血腫將其分為遲髮組41例和非遲髮祖61例。兩組性彆、年齡、蛛網膜下腔齣血髮生率、血漿凝血酶原時間、收縮壓、血小闆計數、血腫量比較，差異均無統計學意義（P >0.05）；兩組髮病至手術時間、顱骨骨摺髮生率、Babins-ki 徵暘性髮生率、基底池受壓髮生率、活化部分凝血活酶時間、血漿凝血酶時間、GCS 評分、舒張壓、纖維蛋白原水平比較，差異均有統計學意義（P <0.05）。進一步行多因素 Logistic 迴歸分析結果顯示，髮病至手術時間、顱骨骨摺、Babinski 徵暘性、血漿凝血酶時間是重型顱腦損傷患者行開顱手術後髮生遲髮性顱內血腫的獨立影響因素（P <0.05）。結論對伴隨顱骨骨摺、Babinski 徵暘性、血漿凝血酶時間延長以及髮病至手術時間較早等齣現髮生遲髮性顱內血腫的獨立危險因素的重型顱腦損傷患者應加彊鑑護併給予早期預防治療，降低遲髮性顱內血腫髮生風險。
목적：탐토중형로뇌손상환자행개로수술후발생지발성로내혈종적위험인소，이기능구개선환자예후질량。방법선취2010년3월-2014년3월부양시인민의원수치적행개로수술치료적중형로뇌손상환자102례，의거환자술후시부발생지발성로내혈종장기분위지발조화비지발조，기록량조환자림상자료，포괄성별、년령、발병지수술시간、로골골절、주망막하강출혈、Babinski 정양성、기저지수압、혈장응혈매원시간、활화부분응혈활매시간、혈장응혈매시간、격랍사가혼미량표（GCS）평분、수축압、서장압、혈소판계수、섬유단백원、혈종량등。채용다인소 Logistic 회귀분석탐토영향환자행개로수술후발생지발성로내혈종적위험인소。결과의거환자술후시부발생지발성로내혈종장기분위지발조41례화비지발조61례。량조성별、년령、주망막하강출혈발생솔、혈장응혈매원시간、수축압、혈소판계수、혈종량비교，차이균무통계학의의（P >0.05）；량조발병지수술시간、로골골절발생솔、Babins-ki 정양성발생솔、기저지수압발생솔、활화부분응혈활매시간、혈장응혈매시간、GCS 평분、서장압、섬유단백원수평비교，차이균유통계학의의（P <0.05）。진일보행다인소 Logistic 회귀분석결과현시，발병지수술시간、로골골절、Babinski 정양성、혈장응혈매시간시중형로뇌손상환자행개로수술후발생지발성로내혈종적독립영향인소（P <0.05）。결론대반수로골골절、Babinski 정양성、혈장응혈매시간연장이급발병지수술시간교조등출현발생지발성로내혈종적독립위험인소적중형로뇌손상환자응가강감호병급여조기예방치료，강저지발성로내혈종발생풍험。
Objective To explore the risk factors of the delayed intracranial hematoma followed by craniotomy in se-vere head injury patients,in order to improve the quality of prognosis of the patients. Methods Clinical data of 102 cases of se-vere head injury patients who treated with craniotomy in People's Hospital of Fuyang from March 2010 to March 2014 were ana-lyzed retrospectively. They were grouped based on the occurrence of delayed intracranial hematoma. The clinical data were recorded in the two groups,including gender of the patients,age,time from onset to operation,the occurrence of fracture of skull,sub-arachnoid hemorrhage,positive Babinski symptoms,compression of basilar cistern,plasma prothrombin time,activated partial thromboplastin time,plasma thrombin time,GCS score,systolic pressure,diastolic pressure,blood platelet count,fibrinogen and volume of hematoma. Multivariate Logistic regression analysis were used to analyze the risk factors for delayed intracranial he-matoma followed by craniotomy. Results The patients were divided into delayed group(41 cases)and non - delayed group(61 cases). The gender,age,incidence of subarachnoid hemorrhage,plasma prothrombin time,systolic pressure,blood platelet count and volume of hematoma showed no statistically significant difference(P > 0. 05). The time from onset to operation,inci-dence of fracture of skull,incidence of positive Babinski symptoms and compression of basilar cistern,activated partial thrombo-plastin time,plasma thrombin time,GCS score,diastolic pressure and fibrinogen level showed statistically significant differences between the two groups(P < 0. 05). Multivariate Logistic regression analysis showed that the time from onset to operation,frac-ture of skull,positive Babinski symptoms and plasma thrombin time were independent factors for delayed intracranial hematoma followed by craniotomy in severe head injury patients(P < 0. 05). Conclusion The severe head injury patients associated with the risk factors of delayed intracranial hematoma such as skull fracture,positive Babinski symptoms,longer plasma thrombin time,early operation and so on should be given intensive care and preventive treatment in order to reduce the risk of delayed in-tracranial hematoma.
