外伤性迟发性颅内血肿的危险因素及其预测价值

摘要

目的：探讨外伤性迟发性颅内血肿（DTICH）的危险因素及其预测价值。方法：收集95例急性颅脑外伤患者的临床资料，分为迟发血肿组（62例）和无血肿复发对照组（33例）。比较两组临床资料，采用Logistic回归模型分析DTICH的危险因素，并以受试者工作特征曲线（ROC）评价相关危险因素的预测价值。结果：与无血肿复发组比较，迟发血肿组患者年龄[（46.72±6.45）岁比（52.18±7.13）岁]明显较大，血肿量[（51.21±11.25） ml比（56.89±12.37） ml]、空腹血糖[（8.13±1.55） mmol／L比（10.62±1.73） mmol／L]、活化部分凝血活酶时间[APTT ，（25.27±6.19） s比（27.35±7.45） s]、凝血酶时间[TT ，（17.53±5.14） s比（21.26±7.31） s ]均明显增加，基底池受压（24.2％比46.8％）、脑挫伤（42.4％比69.4％）、去除骨瓣（45.5％比67.7％）、Babinski征阳性（39.4％比61.3％） 等比例均明显增大， GCS评分[（9.46±3.29）分比（7.63±3.07）分]、收缩压[（146.57±18.23） m m H g比（132.18±17.18） m m H g ]、手术时机[（12.74±4.39） h比（5.47±2.16） h ]等均明显减少， P＜0.05或＜0.01；Logistic回归分析显示，凝血功能（APTT、TT）、颅骨骨折和手术时机为术后迟发血肿的危险因素（OR＝4.076～5.430， P＜0.05或＜0.01），其 ROC曲线下面积分别为0.826、0.748和0.661。结论：凝血功能、颅骨骨折及手术时机是颅脑外伤患者术后迟发性颅脑血肿的危险因素，有较大预测价值。%Objective:To explore the risk factors its predictive value of delayed traumatic intracranial hematoma (DTICH) . Methods:Clinical data of 95 patients with acute craniocerebral trauma were collected .All patients were divided into DTICH group (n=62) and no recurrent hematoma control group (n=33) .Clinical data were compared between two groups ,Lo‐gistic regression model was used to analyze risk factors .Receiver operator characteristic curve (ROC) was used to assess pre‐dictive value of relative risk factors .Results:Compared with no recurrent hematoma group ,there were significant rise in age [(46.72 ± 6.45) years vs .(52.18 ± 7.13) years] ,hematoma volume [(51.21 ± 11.25)ml vs .(56.89 ± 12.37)ml] , level of fasting blood glucose [(8.13 ± 1.55) mmol/L vs .(10.62 ± 1.73) mmol/L] ,activated partial thromboplastin time [APTT ,(25.27 ± 6.19)s vs .(27.35 ± 7.45)s] and thrombin time [TT ,(17.53 ± 5.14)s vs .(21.26 ± 7.31)s] ,significant increase in percentages of basal cistern compression (24.2% vs .46.8% ) ,brain contusion (42.4% vs .69.4% ) ,bone flap removal (45.5% vs .67.7% ) and positive Babinski sign (39.4% vs .61.3% ) , and significant reductions in GCS score [(9.46 ± 3.29) scores vs .(7.63 ± 3.07) scores] ,systolic blood pressure [(146.57 ± 18.23)mmHg vs .(132.18 ± 17.18) mmHg] and timing of surgery [(12.74 ± 4.39)h vs .(5.47 ± 2.16)h] in DTICH group ,P<0.05 or <0.01;Logistic regres‐sion analysis indicated that coagulation function (APTT ,TT) ,skull fracture and timing of surgery were risk factors for post‐operative delayed hematoma(OR=4.076~5.430 ,P<0.05 or <0.01) ,their area under curve of ROC were 0.826 ,0.748 and 0.661 respectively .Conclusion:Coagulation function ,skull fracture and timing of surgery are risk factors and possess considerable predictive value for postoperative delayed craniocerebral hematoma in patients with craniocerebral trauma .