关键词: 重型颅脑损伤, 大骨瓣减压术, 迟发性颅内血肿, 危险因素, 预后

Abstract:

Objective: To explore the risk factors of delayed traumatic intracranial hematoma (DTICH) followed by unilateral large decompressive craniectomy (LDC) and its influence in the prognosis of the severe traumatic brain injury (sTBI) patients, and to improve the successful rate of the rescue.Methods: The clinical data of 130 sTBI patients underwent unilateral LDC were retrospectively analyzed. The patients were divided into DTICH group(n=42) and non-DTICH group(n=88) according to whether the DTICH occurred after operation. The risk factors of DTICH and its influence were contrastively analyzed.Results: The analysis results of the clinical data of patients in two groups showed that preoperative GCS, time from trauma to operation, skull fracture, midline shift > 1 cm, basal cistern disappear, activated partial prothrombin time (APTT), fibrinogen (FIB), and thrombin time (TT) were significantly correlated with the appearance of DTICH (P<0.05). Multivariable Logistic regression analysis showed that the time from trauma to operation, skull fracture, basal cistern disappearing and FIB were the independent risk factors of DTICH (P<0.05). The analysis results of GOS 3 months after operation of the patients in two groups showed that the prognosis of the patients in DTICH group was significantly worse than that in non-DTICH group (P<0.01).Conclusion: For those patients who accompanied with shorter time from trauma to operation, skull fracture, basal cistern disappearing and FIB decrease, the appearance of DTICH should be paid attention. DTICH can affect the prognosis of patients; prevention and early diagnosis are crucial to improve the prognosis of patients.

Key words: severe traumatic brain injury, large decompressive craniectomy, delayed traumatic intracranial hematoma, risk factors, prognosis