CAJ | 학술논문

目的分析急性外伤性硬膜下血肿手术治疗预后的相关因素.方法回顾性分析北京市大兴区人民医院神经外科2007年1月至2012年7月病例资料完整的手术治疗的117例急性硬膜下血肿患者临床资料,应用统计学分析患者预后相关因素.预后评估采用GOS评分,4～5分者为恢复良好.结果术后恢复良好51例(43.59％),死亡46例(39.32％).急性硬膜下血肿恢复良好的相关因素包括:年龄＜40岁、术前GCS评分＞8分、术前无脑疝、从外伤到手术有效减压时间≤4h;无引流静脉损伤;术毕脑肿胀程度轻及脑搏动良好.急性硬膜下血肿患者死亡相关因素包括:年龄＞ 60岁、术前GCS评分≤8分、术前脑疝、从外伤到手术有效减压时间＞4h;引流静脉损伤;术毕脑肿胀明显及脑搏动微弱.经过Logistic回归分析术前GCS评分、术前有无脑疝、术后脑搏动恢复情况是影响患者预后的独立相关因素.结论急性硬膜下血肿患者年龄＜ 40岁、术前GCS评分＞8分、术前无脑疝、术毕脑搏动良好者预后相对好.
목적 분석급성외상성경막하혈종수술치료예후적상관인소.방법 회고성분석북경시대흥구인민의원신경외과2007년1월지2012년7월병례자료완정적수술치료적117례급성경막하혈종환자림상자료,응용통계학분석환자예후상관인소.예후평고채용GOS평분,4～5분자위회복량호.결과 술후회복량호51례(43.59％),사망46례(39.32％).급성경막하혈종회복량호적상관인소포괄:년령＜40세、술전GCS평분＞8분、술전무뇌산、종외상도수술유효감압시간≤4h;무인류정맥손상;술필뇌종창정도경급뇌박동량호.급성경막하혈종환자사망상관인소포괄:년령＞ 60세、술전GCS평분≤8분、술전뇌산、종외상도수술유효감압시간＞4h;인류정맥손상;술필뇌종창명현급뇌박동미약.경과Logistic회귀분석술전GCS평분、술전유무뇌산、술후뇌박동회복정황시영향환자예후적독립상관인소.결론 급성경막하혈종환자년령＜ 40세、술전GCS평분＞8분、술전무뇌산、술필뇌박동량호자예후상대호.
Objective To analyze the factors correlated with the surgical prognosis of patients with traumatic acute subdural hematoma (ASDH).Methods A total of 117 surgical patients for traumatic ASDH between January 2007 and August 2012 were retrospectively reviewed.The clinical factors correlated with prognosis were statistically analyzed.Glasgow outcome score (GOS) was used for prognostic evaluations and favorable prognosis was defined as 4-5 points.Results The percentage of patients with favorable prognosis was 43.59％ and the mortality 39.32％.The factors correlated with favorable prognosis included age ＜ 40 years,pre-operative GCS ＞ 8,no pre-operative herniation,duration between injury and surgical depression ≤4 h,without injury of drainage vein,mild brain edema and good brain palpation; the factors correlated with mortality included age ＞ 60 years,pre-operative GCS ≤8,pre-operative herniation,duration between injury and surgical depression ＞ 4 h,injury of drainage vein,serious brain edema and weak brain palpation Logistic regression confirmed preoperative GCS ＞ 8,no preoperative herniation,injury of drainage vein and postoperative good brain palpation were independent factors associated with favorable prognosis.Conclusion Patients with age ＜ 40 years,preoperative GCS ＞ 8,no preoperative herniation,injury of drainage vein and postoperative good brain palpation tend to have favorable prognoses.