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颅脑创伤患者术中对冲侧血肿清除后颞顶叶着力侧血肿增加的多因素分析
Risk factors of hematoma enlargement in temporo-parietal lobe on impact side during contralateral decompressive surgery in patients with traumatic brain injury
- 第三军医大学学报 2019年41卷第22期 页码：2205-2211
- 作者机构：
1.400042 重庆，陆军军医大学(第三军医大学)大坪医院全军战创伤中心，创伤、烧伤与复合伤国家重点实验室
2.400014 重庆，重庆市急救医疗中心神经外科
- 作者简介：
[张连阳, E-mail: dpzhangly@163.com ZHANG Lianyang, E-mail:dpzhangly@163.com
- 基金信息：重庆市教委科研项目(KJQN201800122);重庆市渝中区科研项目(20180131)
DOI：10.16016/j.1000-5404.201906212
中图分类号： R619;R651.15;R743.34收稿：2019-06-25，
修回：2019-08-13，
纸质出版：2019-11-30
- 稿件说明：
移动端阅览
陈鹏, 张清涛, 周玮, 等. 颅脑创伤患者术中对冲侧血肿清除后颞顶叶着力侧血肿增加的多因素分析[J]. 第三军医大学学报, 2019,41(22):2205-2211.
Peng CHEN, Qingtao ZHANG, Wei ZHOU, et al. Risk factors of hematoma enlargement in temporo-parietal lobe on impact side during contralateral decompressive surgery in patients with traumatic brain injury[J]. Journal of Third Military Medical University, 2019, 41(22): 2205-2211.
陈鹏, 张清涛, 周玮, 等. 颅脑创伤患者术中对冲侧血肿清除后颞顶叶着力侧血肿增加的多因素分析[J]. 第三军医大学学报, 2019,41(22):2205-2211. DOI： 10.16016/j.1000-5404.201906212.
Peng CHEN, Qingtao ZHANG, Wei ZHOU, et al. Risk factors of hematoma enlargement in temporo-parietal lobe on impact side during contralateral decompressive surgery in patients with traumatic brain injury[J]. Journal of Third Military Medical University, 2019, 41(22): 2205-2211. DOI： 10.16016/j.1000-5404.201906212.
摘要
目的
2
探讨颅脑创伤患者对冲侧血肿清除后，术中颞顶叶着力侧血肿增加的发生率及危险因素。
方法
2
对2013年1月至2017年9月重庆市急救医疗中心神经外科收治的47例颅脑创伤患者进行临床资料回顾性研究，其特点为颅脑创伤着力侧为颞顶叶并首先行对冲侧血肿清除。按术中血肿清除后证实为颞顶叶着力侧血肿有无增加，将患者分为增加组和对照组。对两组患者年龄、受伤机制、入院时格拉斯哥昏迷评分(Glasgow coma scale
GCS)、瞳孔反应、术前休克、血糖水平、受伤至手术时间、着力侧血肿类型、着力侧血肿量、着力侧骨折、环池情况、中线移位等因素进行单因素及多因素Logistic回归分析，并比较两组患者术后6个月的预后情况。
结果
2
10例患者术中对冲侧血肿清除后出现急性脑膨出，经证实颞顶叶着力侧血肿增加，其发生率为21.3%。单因素分析结果显示:血糖水平、着力侧血肿量、着力侧骨折、中线移位与血肿增加相关，Logistic回归分析结果显示:着力侧骨折(
OR
=10.58)、着力侧血肿量(
OR
=3.00)为独立危险因素。比较两组患者术后6个月预后情况，发现两组患者预后差异无统计学意义。
结论
2
着力侧骨折及血肿量是导致对冲侧血肿清除后着力侧颞顶叶血肿增加的危险因素，血肿增加后及时发现处理，并不影响最终预后。
Abstract
Objective
2
To analyze the incidence and the risk factors of hematoma enlargement in the temporo-parietal region on the impact side during contralateral decompressive surgery in patients with contrecoup traumatic brain injury.
Methods
2
We retrospectively analyze the clinical data of 47 patients with traumatic brain injuries admitted in the Department of Neurosurgery of Chongqing Emergency Medical Center in 5 years (2013 to 2017). All the patients sustained brain injuries due to head impact in the temporo-parietal lobe and underwent contralateral hematoma evacuation surgeries. According to the changes in hematoma volume in the temporo-parietal region on the impact side during contralateral hematoma evacuation
the patients were divided into hematoma enlargement group and control group without hematoma enlargement. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors for intraoperative hematoma enlargement from age
mechanism of trauma
Glasgow coma scale (GCS) score
pupillary reactivity
onset of preoperative shock
preoperative blood glucose
interval from brain injury to surgery
types and volume of hematoma on the impact side
skull fracture on the impact side
condition of the basal cistern
and midline shift. The outcomes of the patients in 6 months after the operation were compared between the 2 groups.
Results
2
Among all the cases
10 (21.3%) patients showed enlarged hematoma in the temporo-p
arietal region on the impact side after contralateral decompressive surgery. Univariate analysis revealed that blood glucose
volume of hematoma and skull fracture on the impact side
and midline shift were significantly correlated with hematoma enlargement in the temporo-parietal region on the impact side. Logistic regression analyses identified skull fracture (
OR
=10.58) and hematoma volume on the impact side (
OR
=3.00) as the independent risk factors for hematoma enlargement on the impact side after contralateral hematoma evacuation. At 6 months after the operations
no significant differences were found in the outcomes of the patients between the 2 groups.
Conclusion
2
In patients with contrecoup brain injury with impact on the temporo-parietal lobe
a skull fracture on the impact side and a hematoma volume ≥10 mL are risk factors for hematoma enlargement in the temporo-parietal region on the impact side following contralateral decompressive surgery. The occurrence of such hematoma enlargement does not necessarily affect the patients' prognosis if it is timely detected with prompt treatment.
关键词
Keywords
references
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