本文選題：顱腦損傷 + 遲發(fā)性顱內(nèi)血腫��； 參考：《延安大學(xué)》2013年碩士論文

【摘要】：目的：探討顱腦損傷術(shù)后遲發(fā)性顱內(nèi)血腫(delayed traumatic intracranialhematoma，，DTICH)發(fā)生的相關(guān)因素、臨床特點(diǎn)、發(fā)生機(jī)制及其防治措施。加強(qiáng)對本病的警惕性,重視其臨床特點(diǎn)及發(fā)展規(guī)律,合理運(yùn)用動(dòng)態(tài)CT檢查,爭取早期診斷,早期治療,有效提高本病的療效和預(yù)后,降低致殘率和病死率。 方法：回顧性分析2009年1月至2011年12月延安大學(xué)附屬醫(yī)院神經(jīng)外科急性顱內(nèi)血腫清除術(shù)240例患者的臨床資料，其中發(fā)現(xiàn)術(shù)后遲發(fā)性顱內(nèi)血腫的患者25例（病例組），未發(fā)生遲發(fā)性顱內(nèi)血腫的患者215例（對照組）。從性別、年齡、顱腦損傷嚴(yán)重程度、顱腦損傷類型等方面分析這些因素與DTICH發(fā)生的關(guān)系，對觀測指標(biāo)的數(shù)據(jù)進(jìn)行單因素分析和多因素Logistic回歸分析。 結(jié)果：單因素分析顯示重度顱腦損傷、腦挫裂傷、硬膜外血腫、顱骨骨折、手術(shù)時(shí)機(jī)、手術(shù)方式、TT和APTT有顯著相關(guān)性（P㩳0.05)；多因素Logistic回歸分析顯示重度顱腦損傷（OR=3.678，P=0.001）、腦挫裂傷（OR=2.374，P=0.019）、顱骨骨折（OR=1.760，P=0.024）和血漿凝血酶時(shí)間（TT）（OR=1.848，P=0.017）4個(gè)因素為DTICH的高危因素。 結(jié)論：本研究通過回顧性分析240例顱腦損傷后DTICH患者和顱腦損傷后未發(fā)生遲發(fā)性外傷性顱內(nèi)血腫的臨床資料，統(tǒng)計(jì)分析顯示DTICH的發(fā)生與重度顱腦損傷、腦挫裂傷、硬膜外血腫、顱骨骨折、手術(shù)時(shí)機(jī)、手術(shù)方式、TT和APTT有顯著意義（P㩳0.05)。而性別、年齡、受傷機(jī)制、硬膜下血腫、腦內(nèi)血腫、首次CT時(shí)間、PT、低氧血癥、低血壓和術(shù)后并發(fā)癥在兩組中無明顯差異（P㧐0.05）。將單因素分析有顯著意義的自變量進(jìn)行多因素Logistic回歸分析，顯示影響DTICH發(fā)生的危險(xiǎn)因素重度顱腦損傷、腦挫裂傷、顱骨骨折和TT。因此，具有重度顱腦損傷、腦挫裂傷、顱骨骨折和TT等高危因素的患者易在顱腦損傷術(shù)后并發(fā)遲發(fā)性顱內(nèi)血腫。鑒于顱腦損傷發(fā)生率不斷上升的趨勢，且死亡率和致殘率高，給社會(huì)造成的巨大經(jīng)濟(jì)損失和身心傷害，因此我們應(yīng)該重視顱腦損傷的臨床救治，努力改進(jìn)顱腦創(chuàng)傷急救體系及監(jiān)測體系，加強(qiáng)規(guī)范化治療和基礎(chǔ)研究，為我們神經(jīng)外科醫(yī)師提供更好的理論和技術(shù)支持。如更加規(guī)范GCS評分標(biāo)準(zhǔn)，進(jìn)一步改進(jìn)影像學(xué)和功能檢查技術(shù)，改進(jìn)相關(guān)監(jiān)測設(shè)備，神經(jīng)干細(xì)胞移植，加強(qiáng)物理和康復(fù)治療，最大限度的提高顱腦損傷救治水平，減輕顱腦損傷給社會(huì)帶來的負(fù)面影響。本組研究是一項(xiàng)非隨機(jī)、回顧性研究，因此存在潛在的偏差和變異，術(shù)后遲發(fā)性顱內(nèi)血腫的患者僅為25例，樣本量偏小，對于DTICH發(fā)生的危險(xiǎn)因素、臨床特點(diǎn)、及其相關(guān)的發(fā)生機(jī)制還有待更大樣本量的資料、進(jìn)行定量控制的前瞻性研究來證實(shí)，從而進(jìn)一步調(diào)查與評估DTICH發(fā)生的獨(dú)立危險(xiǎn)因素。
[Abstract]:Objective: to investigate the related factors, clinical characteristics, pathogenesis and preventive measures of delayed intracranial hematoma (delayed traumatic) after craniocerebral injury. We should pay more attention to the clinical characteristics and development rules of the disease, make rational use of dynamic CT examination, strive for early diagnosis and early treatment, effectively improve the curative effect and prognosis of the disease, and reduce the rate of disability and mortality. Methods: the clinical data of 240 patients with acute intracranial hematoma removal in neurosurgery department of Yan'an University from January 2009 to December 2011 were retrospectively analyzed. There were 25 cases of delayed intracranial hematoma (case group) and 215 cases of control group (control group). The relationship between these factors and DTICH was analyzed from gender, age, severity of craniocerebral injury and type of craniocerebral injury. Univariate analysis and multivariate logistic regression analysis were used to analyze the data of observed indexes. Results: univariate analysis showed that severe craniocerebral injury, cerebral contusion and laceration, epidural hematoma, skull fracture, timing of operation, mode of operation and APTT were significantly correlated (P0. 05). Multivariate logistic regression analysis showed that the risk factors of DTICH were severe craniocerebral injury (OR3. 678), cerebral contusion and laceration (OR2. 374 P0. 019), skull fracture (OR1. 760) and plasma thrombin time (TT) (OR1. 848P0. 017). Conclusion: the clinical data of 240 patients with DTICH after craniocerebral injury and no delayed traumatic intracranial hematoma after craniocerebral injury were analyzed retrospectively. The statistical analysis showed that DTICH was associated with severe craniocerebral injury, cerebral contusion and laceration, and epidural hematoma. There were significant differences in cranial fracture, surgical timing, operation mode, TT and APTT (P < 0.05). Sex, age, injury mechanism, subdural hematoma, intracerebral hematoma, PTT, hypoxemia, hypotension and postoperative complications were not significantly different between the two groups (P0. 05). Multivariate logistic regression analysis showed that the risk factors of DTICH were severe craniocerebral injury, brain contusion and laceration, skull fracture and TTT. Therefore, patients with high risk factors such as severe craniocerebral injury, brain contusion, skull fracture and TT are prone to develop delayed intracranial hematoma after craniocerebral injury. In view of the increasing incidence of craniocerebral injury and the high mortality and disability rate, the great economic loss and physical and mental injury caused to the society, we should pay attention to the clinical treatment of craniocerebral injury. To improve the first aid system and monitoring system of craniocerebral trauma, to strengthen the standardized treatment and basic research, to provide better theoretical and technical support for our neurosurgeons. Such as more standardized GCS scoring standards, further improvement of imaging and functional examination techniques, improvement of related monitoring equipment, transplantation of neural stem cells, enhancement of physical and rehabilitation treatment, and maximum improvement of the level of treatment for craniocerebral injury. To reduce the negative effects of brain injury on society. This study was a non-random and retrospective study, so there were potential deviations and variations. There were only 25 patients with delayed intracranial hematoma after operation. The sample size was small. The clinical characteristics of DTICH were analyzed. Further investigation and evaluation of the independent risk factors of DTICH can be carried out through prospective quantitative control studies.
【學(xué)位授予單位】：延安大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R651.15

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本文編號(hào)：2055159