颅脑损伤去骨瓣减压术后硬膜下积液的临床特点及危险因素分析

王耿焕; 沈和平; 褚正民; 沈建国; 张李涛; 朱坤灿

doi:10.16766/j.cnki.issn.1674-4152.002323

颅脑损伤去骨瓣减压术后硬膜下积液的临床特点及危险因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002323

1.
嘉兴学院附属第二医院神经外科，浙江嘉兴 314000
2.
嘉兴学院附属第二医院神经内科，浙江嘉兴 314000

基金项目:

浙江省医药卫生科技计划项目 2022KY1257

嘉兴市科技计划项目 2018AD32004

详细信息

通讯作者:
沈和平, E-mail: shenege1977@126.com

中图分类号: R651.15
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出版历程
- 收稿日期: 2021-03-10
- 网络出版日期: 2022-03-04

Clinical features and risk factors of subdural effusion following decompressive craniectomy in patients with traumatic brain injury

1.
Department of Neurosurgery, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang 314000, China

摘要

摘要: 目的探讨颅脑损伤去骨瓣减压术后硬膜下积液的临床特点，分析其影响因素，为早期进行积极预防和干预提供临床依据。方法选择嘉兴学院附属第二医院2010年1月—2019年11月收治的颅脑损伤去骨瓣减压术后患者608例为观察对象，根据术后是否继发硬膜下积液分为硬膜下积液组(120例)和无硬膜下积液组(488例)，分析硬膜下积液组的临床特征及影响因素。结果 608例患者中出现硬膜下积液120例，硬膜下积液发生在手术后4~22(10.3±4.2)d，积液量为12.2~120.8(25.4±10.3)mL，硬膜下积液位于一侧97例，双侧23例，95例保守治疗，25例手术治疗。单因素分析结果显示，积液组与无积液组患者性别、年龄、血肿量、入院格拉斯哥昏迷量表(GCS)评分、中线移位、大骨瓣、双侧开颅、糖尿病差异有统计学意义(均P＜0.05)。多因素logistic回归分析显示，年龄、血肿量、入院GCS评分、中线移位、大骨瓣是去骨瓣减压术后硬膜下积液发生的影响因素(均P＜0.05)。结论颅脑损伤去骨瓣减压术后硬膜下积液发生率高。年龄大、血肿量大、入院GCS评分低、中线移位、大骨瓣是去骨瓣减压术后硬膜下积液发生的危险因素。
- 颅脑损伤 /
- 硬膜下积液 /
- 去骨瓣减压 /
- 危险因素
Abstract: Objective To investigate the clinical characteristics of subdural effusion following decompressive craniectomy in patients with traumatic brain injury and analyse its influencing factors to provide clinical evidence for early active prevention and intervention. Methods A total of 608 patients with craniocerebral injury treated with decompressive craniectomy from January 2010 to November 2019 in the Second Affiliated Hospital of Jiaxing University were selected as participants. They were divided into the subdural effusion group (120 cases) and the no subdural effusion group (488 cases). The clinical characteristics of the subdural effusion group were analysed, and various related factors of the two groups were analysed and compared. Results A total of 120 cases of subdural effusion occurred in 608 patients 4-22(10.3±4.2)d after surgery. The effusion volume was 12.2-120.8(25.4±10.3)mL. Subdural effusion was located on one side in 97 cases and on both sides in 23 cases; 95 cases were treated conservatively, and 25 cases were treated surgically. Univariate analysis showed that gender, age, hematoma volume, admission glasgow coma scale(GCS), midline shift, large bone flap, bilateral craniotomy, and diabetes were statistically different (P < 0.05). Univariate analysis showed that there were significant differences in gender, age, hematoma volume, admission GCS, median shift, large bone flap, bilateral craniotomy and diabetes (all P < 0.05). Multivariate logistic regression analysis showed that age, hematoma volume, admission GCS score, midline displacement and large bone flap were the influencing factors of subdural effusion after bone flap decompression (all P < 0.05). Conclusion The incidence of subdural effusion after decompressive craniectomy is high. Age, haematoma volume, GCS, midline shift and large bone flap are risk factors for subdural effusion following decompressive craniectomy in patients with traumatic brain injury.
- Traumatic brain injury /
- Subdural effusion /
- Decompressive craniectomy /
- Risk factors

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表 1 2组颅脑损伤患者临床特征比较

组别	例数	性别(男/女, 例)	年龄(x±s, 岁)	血肿量(x±s, mL)	入院GCS评分(x±s, 分)	中线移位[例(%)]	大骨瓣[例(%)]	双侧开颅[例(%)]	脑室出血[例(%)]
硬膜下积液组	120	101/9	62.2±14.2	52.2±8.6	7.5±1.2	111(92.5)	112(93.3)	15(12.5)	20(16.7)
无硬膜下积液组	488	349/139	52.5±16.7	45.6±6.8	8.6±1.4	410(84.0)	408(83.6)	31(6.3)	53(10.9)
统计量		19.866^a	5.862^b	9.010^b	25.200^b	5.653^a	5.382^a	5.205^a	3.073^a
P值		< 0.001	< 0.001	< 0.001	< 0.001	0.017	0.020	0.023	0.080

组别	例数	蛛网膜下腔出血[例(%)]	合并损伤[例(%)]		颅内感染[例(%)]	高血压[例(%)]	糖尿病[例(%)]	脑梗死[例(%)]	早期癫痫[例(%)]
硬膜下积液组	120	115(95.8)	69(57.5)		7(5.8)	24(20.0)	18(15.0)	10(8.3)	9(7.5)
无硬膜下积液组	488	459(94.1)	241(49.4)		24(4.9)	78(16.0)	42(8.6)	29(5.9)	26(5.3)
统计量		0.575^a	2.538^a		0.159^a	1.113^a	4.426^a	0.917^a	0.838^a
P值		0.448	0.111		0.690	0.292	0.035	0.338	0.360
注：^a为χ²值，^b为t值。

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表 2 颅脑损伤患者继发硬膜下积液的影响因素分析

项目	B	SE	Wald χ²	P值	OR值	95% CI
年龄	0.969	0.446	4.728	0.030	2.635	1.100~6.310
血肿量	1.651	0.836	3.897	0.048	5.208	1.256~15.235
入院GCS评分	1.043	0.435	5.734	0.017	2.837	1.208~6.662
中线移位	0.820	0.356	5.310	0.021	2.271	1.130~4.564
大骨瓣	1.003	0.423	5.623	0.018	2.725	1.190~6.250

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