老年长期抗凝患者轻微头部创伤后无症状颅内出血的临床特征研究

张国庆; 陈登婷; 胡飞; 韩国强; 谭赢

doi:10.11659/jjssx.08E025089

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老年长期抗凝患者轻微头部创伤后无症状颅内出血的临床特征研究

临床研究 | 更新时间：2026-05-25

- 老年长期抗凝患者轻微头部创伤后无症状颅内出血的临床特征研究
- Clinical characteristics study of asymptomatic intracranial hemorrhage after minor head trauma in elderly patients with long-term anticoagulation
- 局解手术学杂志 2026年35卷第5期页码：428-431
- 作者机构：
  
  1.黔南州人民医院神经外科，贵州都匀 558000
  2.贵州省人民医院神经外科，贵州贵阳 550001
- 作者简介：
  
  韩国强，E-mail：15976873806@163.com
- 基金信息：
  
  贵州省科学技术厅科技计划项目（黔科合基础-ZK［2024］一般483）
- DOI：10.11659/jjssx.08E025089
  中图分类号： R651.15;R816.1
- 收稿：2025-08-22，
  
  纸质出版：2026-05-25
- 稿件说明：
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张国庆,陈登婷,胡飞等.老年长期抗凝患者轻微头部创伤后无症状颅内出血的临床特征研究[J].局解手术学杂志,2026,35(05):428-431.

ZHANG Guo-qing,CHEN Deng-ting,HU Fei,et al.Clinical characteristics study of asymptomatic intracranial hemorrhage after minor head trauma in elderly patients with long-term anticoagulation[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(05):428-431.
张国庆,陈登婷,胡飞等.老年长期抗凝患者轻微头部创伤后无症状颅内出血的临床特征研究[J].局解手术学杂志,2026,35(05):428-431. DOI： 10.11659/jjssx.08E025089.

ZHANG Guo-qing,CHEN Deng-ting,HU Fei,et al.Clinical characteristics study of asymptomatic intracranial hemorrhage after minor head trauma in elderly patients with long-term anticoagulation[J].JOURNAL OF REGIONAL ANATOMY AND OPERATIVE SURGERY,2026,35(05):428-431. DOI： 10.11659/jjssx.08E025089.

摘要

目的

探讨老年长期抗凝患者轻微头部创伤后无症状颅内出血的临床特征及危险因素。

方法

回顾性分析2020年6月至2024年6月黔南州人民医院、贵州省人民医院收治的227例长期接受抗凝治疗的老年轻微头部创伤患者的临床资料，根据CT检查结果将患者分为出血组（17例）与无出血组（210例）。对比2组患者各类抗凝药物使用情况、创伤性脑损伤（TBI）相关症状发生情况，采用二元

Logistic

回归模型分析老年抗凝患者轻微创伤后颅内出血的独立危险因素。

结果

乙酰水杨酸（ASA）为老年长期抗凝患者最常用的抗凝药物，2组患者ASA、新型口服抗凝药（NOAC）、香豆素类及其他血小板聚集抑制剂（PAI）使用率比较，差异均无统计学意义（

0.05）；出血组患者低分子肝素（LMWH）使用率显著高于无出血组（

0.001）。227例老年患者轻微创伤后颅内出血发生率为7.49%，其中47.06%的出血患者无任何TBI相关神经症状；出血组患者TBI相关神经症状总发生率为52.94%，显著高于无出血组的27.62%（

=0.028）。二元

Logistic

回归分析显示，使用LMWH是老年抗凝患者轻微创伤后颅内出血的独立危险因素（

=11.24，95%

：3.05~41.42，

0.001）。

结论

老年长期抗凝患者轻微头部创伤后存在较高的隐匿性无症状颅内出血风险，传统以症状阳性为核心的评估策略难以有效排除颅内出血，颅脑CT平扫是筛查此类患者无症状颅内出血的可靠手段；此外，临床需重点关注接受LMWH治疗的高风险人群。

Abstract

Objective

To investigate the clinical characteristics and risk factors of asymptomatic intracranial hemorrhage after minor head trauma in elderly patients with long-term anticoagulation.

Methods

A retrospective analysis was performed on the clinical data of 227 elderly patients with minor head trauma who received long-term anticoagulant therapy in People's Hospital of Qiannan and Guizhou Provincial People's Hospital from June 2020 to June 2024. According to CT findings， patients were divided into the hemorrhage group （17 cases） and the non-hemorrhage group （210 cases）. The use of various anticoagulants and the incidence of traumatic brain injury （TBI）-related symptoms were compared between the two groups. Binary

Logistic

regression was used to analyze the independent risk factors for intracranial hemorrhage after minor head trauma in elderly anticoagulated patients.

Results

Acetylsalicylic acid （ASA） was the most commonly used anticoagulant in elderly patients with long-term anticoagulation. There were no statistically significant differences in the usage rates of ASA， novel oral anticoagulants （NOAC）， coumarins， and other platelet aggregation inhibitor （PAI） between the two groups （

0.05）. The usage rate of low molecular weight heparin （LMWH） was significantly higher in the hemorrhage group than that in the non-hemorrhage group （

0.001）. The incidence of intracranial hemorrhage after minor head trauma in the 227 elderly patients was 7.49%，among whom 47.06% of hemorrhagic patients had no TBI-related neurological symptoms. The total incidence of TBI-related neurological symptoms in the hemorrhage group was 52.94%， which was significantly higher than 27.62% in the non-hemorrhage group （

0.028）. Binary

Logistic

regression analysis showed that LMWH use was an independent risk factor for intracranial hemorrhage

after minor head trauma in elderly anticoagulated patients （

=11.24， 95%

： 3.05 to 41.42，

0.001）.

Conclusion

Elderly patients with long-term anticoagulation have a relatively high risk of concealed asymptomatic intracranial hemorrhage following minor head trauma. Traditional symptom-centered evaluation strategies cannot effectively rule out intracranial hemorrhage， and non-contrast cranial CT is a reliable method for screening asymptomatic intracranial hemorrhage in such patients. In addition， clinical attention should be focused on high-risk patients receiving LMWH therapy.

关键词

Keywords

references

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