Objective To analyze the influencing factors of postoperative delayed intracranial hematoma in severe craniocerebral trauma patients treated by unilateral large-bone flap decompression.Methods A total of 86 severe craniocerebral trauma patients undergoing unilateral large-bone flap decompression were selected in the Affiliated Hospital of Hebei University from January 2015 to January 2017,and they were divided into A group(complicated with delayed intracranial hematoma,n=21) and B group(did not complicate with delayed intracranial hematoma,n=65) according to the incidence of postoperative delayed intracranial hematoma.General information,craniocerebral CT examination results and laboratory examination results were compared between the two groups,and multivariate Logistic regression analysis was used to analyze the influencing factors of postoperative delayed intracranial hematoma in severe craniocerebral trauma patients treated by unilateral large-bone flap decompression.Results Glasgow Outcome Scale grade in B group was statistically significantly better than that in A group 3 months after operation(P<0.05).No statistically significant differences of gender,age,duration of operation, history of hypertension or diabetes,incidence of pupil change or midline shift,PLT,WBC or PT was found between the two groups(P>0.05),while there were statistically significant differences of Glasgow Coma Scale score,duration between trauma and operation,incidence of skull fracture,Rotterdam CT score before operation,FIB,APTT and TT between the two groups(P<0.05).Multivariate Logistic regression analysis results showed that,duration between trauma and operation〔OR=0.964, 95%CI(0.933,0.997)〕was the protective factor of postoperative delayed intracranial hematoma in severe craniocerebral trauma patients treated by unilateral large-bone flap decompression,while skull fracture〔OR=6.013,95%CI(2.052, 17.637)〕and Rotterdam CT score before operation〔OR=9.375,95%CI(3.110,26.261)〕were the risk factors(P<0.05). Conclusion Duration between trauma and operation is the protective factor of postoperative delayed intracranial hematoma in severe craniocerebral trauma patients treated by unilateral large-bone flap decompression,while skull fracture and Rotterdam CT score before operation are the risk factors.%目的 分析重型颅脑损伤患者单侧去大骨瓣减压术后迟发性颅内血肿的影响因素.方法 选取2015年1月—2017年1月于河北大学附属医院行单侧去大骨瓣减压术的重型颅脑损伤患者86例,根据迟发性颅内血肿发生情况分为A组(发生迟发性颅内血肿,n=21)与B组(未发生迟发性颅内血肿,n=65).比较两组患者一般资料、颅脑CT检查结果和实验室检查指标,重型颅脑损伤患者单侧去大骨瓣减压术后迟发性颅内血肿的影响因素分析采用多因素Logistic回归分析.结果 B组患者术后3个月格拉斯哥预后量表分级优于A组(P<0.05).两组患者性别、年龄、手术时间、高血压病史、糖尿病病史、瞳孔改变发生率、中线偏移发生率、血小板计数、白细胞计数、凝血酶原时间比较,差异无统计学意义(P>0.05);两组患者格拉斯哥昏迷量表评分、创伤至手术时间、颅骨骨折发生率、术前Rotterdam CT评分、纤维蛋白原、活化部分凝血活酶时间、凝血酶时间比较,差异有统计学意义(P<0.05).多因素Logistic回归分析结果显示,创伤至手术时间〔OR=0.964,95%CI(0.933,0.997)〕是重型颅脑损伤患者单侧去大骨瓣减压术后迟发性颅内血肿的保护因素,颅骨骨折〔OR=6.013,95%CI(2.052,17.637)〕、术前Rotterdam CT评分〔OR=9.375,95%CI(3.110,26.261)〕是重型颅脑损伤患者单侧去大骨瓣减压术后迟发性颅内血肿的危险因素(P<0.05).结论 创伤至手术时间是重型颅脑损伤患者单侧去大骨瓣减压术后迟发性颅内血肿的保护因素,颅骨骨折、术前Rotterdam CT评分是重型颅脑损伤患者单侧去大骨瓣减压术后迟发性颅内血肿的危险因素.
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