临床医学论著

慢性硬膜下血肿钻孔引流术后复发的影响因素分析

  • 茅帅东 ,
  • 黄欢
展开
  • 同济大学附属上海市第十人民医院崇明分院,上海 202157

收稿日期: 2022-05-05

  网络出版日期: 2023-01-09

Analysis of the influencing factors of recurrence of chronic subdural hematoma after drilling and drainage

  • MAO Shuaidong ,
  • Huang Huan
Expand
  • Chongming Branch of Shanghai Tenth People's Hospital, Tongji University, Chongming District, Shanghai 202157

Received date: 2022-05-05

  Online published: 2023-01-09

摘要

目的: 探讨慢性硬膜下血肿钻孔引流术后复发的影响因素。方法: 选取2015年1月~2021年12月在同济大学附属上海市第十人民医院崇明分院钻孔引流的患者198例,回顾分析其一般情况、既往史、术前术后影像学资料、手术和术后管理以及复发情况。结果: 198例慢性硬膜下血肿钻孔引流患者,36例出现复发,复发率18.18 %。其中术前CT提示血肿有分隔、凝血功能异常、术后残余气体量以及术后是否服用他汀类药物复发组与未复发组比较差异有统计学意义(P<0.05)。多因素Logistic回归分析提示术前CT提示血肿是否分隔、术后残余气体≥55 mL以及术后是否服用他汀类药物是慢性硬膜下血肿钻孔术后复发的影响因素。结论: 术前CT提示血肿是否分隔、术后残余气体≥55 mL以及术后是否服用他汀类药物是慢性硬膜下血肿钻孔术后复发的影响因素。

本文引用格式

茅帅东 , 黄欢 . 慢性硬膜下血肿钻孔引流术后复发的影响因素分析[J]. 包头医学院学报, 2022 , 38(10) : 70 -73 . DOI: 10.16833/j.cnki.jbmc.2022.10.014

Abstract

Objective: To investigate the influential factors of recurrence after drilling and drainage of chronic subdural hematoma. Methods: A total of 198 patients who received drilling and drainage in Chongming Branch of Shanghai Tenth People's Hospital affiliated to Tongji University from January 2015 to December 2021 were selected to retrospectively analyze their general situation, past history, preoperative and postoperative imaging data, surgical and postoperative management, and recurrence. Results: 36 patients Of 198 with chronic subdural hematoma had recurrence. The recurrence rate was 18.18 %. There were statistically significant differences between the recurrence group and the non-recurrence group (P<0.05) as indicated by preoperative CT with separated hematoma, abnormal coagulation function, postoperative residual gas volume and whether to take statins after surgery. Multivariate Logistic regression analysis indicated that whether the hematoma was separated by CT before surgery, residual gas ≥55 mL after surgery, and whether the use of statins were the influencing factors for the recurrence of chronic subdural hematoma after drilling. (P<0.05). Conclusion: Whether the hematoma is separated by CT before surgery, residual gas ≥55 ml after surgery, and whether statins drug are taken after surgery are the influencing factors of recurrence after drilling and drainage of chronic subdural hematoma.

参考文献

[1] Lee KS.Chronic subdural hematoma in the aged, trauma or degeneration[J].J Korean Neurosurg, 2016, 59(1):1-5.
[2] Farhat Neto J, Araujo JL, Ferraz VR, et al.Chronic subdural hematoma:epidemiological and prognostic analysis of 176 cases[J].Rev Col Bras Cir, 2015, 42(5):283-287.
[3] You W, Zhu Y, Wang Y, et al.Prevalence of and risk factors for recurrence of chronic subdural hematoma[J].Acta Neurochirurgica, 2018, 160(5):893-899.
[4] 徐进, 曹铖, 杨国庆, 等.分隔型慢性硬膜下血肿复发的影像学因素分析[J].临床神经外科杂志, 2022, 19(02):217-220.
[5] 朱卿, 王中勇, 张檀, 等.硬质神经内镜辅助手术治疗慢性硬膜下血肿的临床疗效[J].中国内镜杂志, 2017, 23(6):52-57
[6] 吴俊, 许文辉, 马铁梁, 等.神经内镜血肿清除术与软通道引流术对慢性硬膜下血肿的疗效分析[J].临床神经外科杂志, 2019, 16(06):492-496.
[7] 李新才.慢性硬膜下血肿钻孔引流术后颅内积气对预后影响的临床研究[D].蚌埠:蚌埠医学院, 2017.
[8] 易勇, 王强平, 周章明, 等.慢性硬膜下血肿钻孔引流术中冲洗与不冲洗疗效对比研究[J].华西医学, 2017, 32(02):213-216.
[9] Wang D, Li T, Tian Y, et al.Effects of atorvastatin on chronic subdural hematoma:a preliminary report from three medical centers[J].J Neurol Sci, 2014, 336(1/2):237-242.
[10] 陈锐锋, 朱安林.微创钻孔引流术联合阿托伐他汀对慢性硬膜下血肿患者术后并发症及复发率的影响[J].安徽医学, 2019, 40(01):62-65.
[11] 秦晓雅, 万力源, 赵晓平, 等.阿托伐他汀辅助手术治疗慢性硬膜下血肿临床疗效的Meta分析[J].实用心脑肺血管病杂志, 2019, 27(08):26-30.
[12] 傅楚华, 陈波, 王宁, 等.阿托伐他汀治疗术后复发慢性硬膜下血肿的疗效观察[J].中华神经创伤外科电子杂志, 2016, 2(03):136-139.
[13] 王凯, 杨永锋, 王欢, 等.慢性硬膜下血肿患者钻孔引流术后复发相关因素的回顾性研究[J].实用心脑肺血管病杂志, 2019, 27(08):10-14.
[14] 姚文益, 殷玉华.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[J].上海交通大学学报(医学版), 2018, 38(04):435-438.
[15] Kamenova M, Nevzatie, Lutz K, et al.Burr-hole drainage for chronic subdural hematoma under low-dose acetylsalicylic acid:a comparative risk analysis study [J].World Neurosurg, 2017, 100:594-600.
[16] Ryu SM, Kim JS, Hong SC, et al.331 Early Warfarin resumption following burr-Hole drainage for chronic subdural hematoma[J].Neurosurgery, 2018, 65(CN_suppl_1 Suppl 1).
[17] 陈卫良, 朱祖建, 苏稳, 等.阿托伐他汀联合地塞米松对老年慢性硬膜下血肿钻孔引流术后复发的预防[J].中华老年心脑血管病杂志, 2021, 23(03):293-295.
[18] Hashimoto T, Chashi T, Watanabe D, et al.Usefulness of embolization of the middle meningeal artery for refractory chronic subdural hematomas [J].Surg Neurol Int, 2013, 4(1):104.
[19] 范小璇.慢性硬膜下血肿治疗现状及发病机制的思考、分析[J].实用心脑肺血管病杂志, 2019, 27(08):1-5.
[20] 高闯.慢性硬膜下血肿发病机制及保守治疗方案探索[D].天津:天津医科大学, 2019.
文章导航

/