上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2018, Vol. 38 ›› Issue (4): 435-.doi: 10.3969/j.issn.1674-8115.2018.04.015

• 论著·临床研究 • 上一篇    下一篇

慢性硬膜下血肿预后相关因素及双侧出血的危险因素分析

姚文益，殷玉华   

  1. 上海交通大学医学院附属仁济医院神经外科，上海200001
  • 出版日期:2018-04-28 发布日期:2018-05-03
  • 通讯作者: 殷玉华，电子信箱：yinyuhuacn@163.com。
  • 作者简介:姚文益（1992—），男，硕士生；电子信箱：wenyi0113@126.com。

Prognostic analysis and bilateral bleeding risk factor analysis of chronic subdural hematoma

YAO Wen-yi, YIN Yu-hua   

  1. Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200001, China
  • Online:2018-04-28 Published:2018-05-03

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摘要： 目的·分析影响慢性硬膜下血肿预后的相关因素，探讨双侧出血的危险因素。方法·收集440例行钻孔引流治疗的慢性硬膜下血肿患者的临床资料，包括病史、体征、凝血功能检查及影像学检查结果。预后相关影响因素采用Spearman相关分析及有序Logistic回归分析；双侧出血危险因素采用单因素分析及多因素Logistic回归分析。结果· Spearman相关分析结果显示年龄、既往抗凝血药物服用史、是否为双侧血肿、血肿腔厚度、术后第1日积气量及术前Markwalder分级与术后Markwalder分级相关（均P<0.05）；有序Logistic回归分析结果显示既往抗凝药物服用史及术前Markwalder分级是术后Markwalder分级的独立危险因素（P0.028，P0.000）；双侧出血的单因素分析结果显示年龄、既往抗凝血药物服用史及凝血活酶时间在单、双侧慢性硬膜下血肿患者之间比较，差异具有统计学意义（均P<0.05）；Logistic回归分析结果显示凝血活酶时间是双侧慢性硬膜下血肿形成的独立危险因素（OR1.147，95% CI为1.005～1.309，P0.042）。结论·年龄、既往抗凝血药物服用史与慢性硬膜下血肿双侧出血关系密切；而慢性硬膜下血肿患者术前Markwalder分级越高，术后Markwalder分级越高，且既往未服用抗凝血药物的患者预后优于服用药物者。

关键词: 慢性硬膜下血肿, 双侧出血, 危险因素, 预后分析

Abstract:

Objective · To analyse the relating factors that influence the prognosis of chronic subdural hematoma(CSDH) after drilling drainage and to explore the bilateral bleeding risk factors of CSDH. Methods · Four hundred and forty patients with CSDH who underwent drilling drainage were retrospectively analysed. Clinical data, including medical history, signs, blood coagulation function and imaging examination were collected. Spearman correlation analysis and ordinal Logistic regression analysis were performed to assess the relationships between various variables and the prognosis, and univariate analysis and multivariate Logistic regression analysis were performed to explore the risk factors that lead to the occurrence of bilateral bleeding. Results · Spearman correlation analysis indicated that age, medication history of anticoagulant drugs, bilateral hematoma or not, the thickness of the hematoma and volume of intracranial gas on the first post-surgery day and preoperative Markwalder grade were associated with postoperative Markwalder grade (P<0.05). Ordinal Logistic regression analysis showed that medication history of anticoagulant drugs and preoperative Markwalder grade were the independent risk factors (P0.028, P0.000). Univariate analysis of the bilateral bleeding indicated that age, medication history of anticoagulant drugs and thrombin time were statistically different between unilateral and bilateral CSDH (P<0.05). Multivariate Logistic regression analysis revealed that thrombin time was the independent risk factor (OR1.147, 95%CI 1.005-1.309, P0.042). Conclusion · Age and medication history of anticoagulant drugs were closely related to the bilateral chronic subdural hematoma. The higher the preoperative Markwalder grade is, the higher the postoperative Markwalder grade is. The prognosis of patients without anticoagulant drugs is better than those users.

Key words: chronic subdural hematoma, bilateral bleeding, risk factors, prognostic analysis

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