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1、急性硬膜下血肿预后相关因素的探讨作者：李季林，盛罗平，陆林其，肖建，陈雪林，于如同，陈仁辉，陈华，顾泉【摘要】目的探讨影响颅脑损伤急性硬膜下血肿预后的相关因素。方法回顾性总结2000年3月～2009年3月手术治疗256例急性硬膜下血肿患者术前及术后临床资料，通过logistic回归分析评价影响患者预后的相关危险因素。结果术后恢复良好患者占42.2%，病死率为39.8%。影响急性硬膜下血肿术后是否恢复良好的主要因素包括：年龄(OR=4.91,P=0.002)、术前瞳孔变化(OR=3.73,P=0.003)、术前GC
2、S评分(OR=5.64,P=0.000)、术中脑肿胀(OR=3.71,P=0.009)。急性硬膜下血肿患者死亡的影响因素：术前瞳孔变化(OR=2.60,P=0.023)、术前GCS评分(OR=4.66,P=0.000)、术中脑肿胀(OR=4.16,P=0.001)、术前低血压或低血氧(OR=5.47,P=0.000)。而术前头颅CT中线偏移程度、血肿量及血肿厚度、伤后手术时间与术后预后有关，但不是主要影响因素。结论急性硬膜下血肿患者年龄小于40岁、术前GCS评分较高、术前瞳孔光反射存在、术前无低血压和低血氧、无脑
3、肿胀患者恢复相对较好。【关键词】急性硬膜下血肿;脑肿胀;预后 Abstract：ObjectiveToinvestigatetherelevant8factorsaffectingtheprognosisoftraumaticacutesubduralhematoma(ASDH)incraniocerebralinjury.MethodsThepreoperativeandpostoperativedataof256patientsinourhospitalswhounderwentsurgicalinterv
4、entionfortraumaticASDHwerereviewed.Therelevantriskfactorsaffectingtheprognosisofthepatientswereevaluatedwithmultivariatelogisticregressionanalysis.ResultsFunctionalrecoverywasachievedin42.2%ofthepatientsandtheoverallmortalitywas39.8%.Thefactorscontributingtot
5、hegoodfunctionalrecoveryofASDHincludedage(OR=4.91,P=0.002),preoperativepupillaryvariations(OR=3.73,P=0.003),preoperativeGCSscore(OR=5.64,P=0.000)andintraoperativeacutebrainswelling(ABS)(OR=4.16,P=0.001);preoperativepupillaryvariations(OR=2.60,P=0.023),preoper
6、ativeGCSscore(OR=4.66,P=0.000),andintraoperativeABS(OR=4.16,P=0.001),aswellaspreoperativehypotensionandhypoximia(OR=5.47,P=0.000)wereindependentpredictorsformortality.AlthoughpreoperativeCTcramidlineshift,thicknessandvolumeofhematoma,andposttraumatictimeforsu
7、rgerywereassociatedwithpostoperativeprognosis,thesevariableswerecorrelatedwithfunctionalrecoveryinunivariateanalyses.ConclusionFunctionalrecoveryismorelikelytobeachievedinpatients8under40yearsofage,inthepresenceofhigherGCSscoreandpupillightreflex,andabsenceof
8、preoperativehypotensionorhypoxemiapreoperativelyaswellasABSduringsurgery. Keywords:acutesubduralhematoma;brainswelling;prognosis 急性硬膜下血肿(acutesubduralhematoma,ASDH)是临床上常见的颅脑损伤，多需要手术治疗，发
