单侧和双侧慢性硬脑膜下血肿的临床特点分析

Comparative analysis of clinical features in unilateral and bilateral chronic subdural hematoma

摘要:

目的  对比分析单侧和双侧慢性硬脑膜下血肿（CSDH）的临床特点，为临床治疗提供参考依据。方法  回顾性收集2009年5月-2015年12月在该院神经外科收治的98例慢性硬脑膜下血肿患者的临床资料，主要观察指标有人口统计学特点、合并疾病、临床症状、诱发因素、电子计算机断层扫描（CT）影像学特征、术后并发症，死亡情况及卡氏评分活动指数。结果  双侧CSDH发生率为24.5%（24/98），性别比（男∶女=2∶1），双侧CDSH患者较单侧CDSH患者年龄大（75.1±3.6）vs（70.1±7.2）岁（t =4.072，P <0.001），合并糖尿病概率更高（45.8% vs 17.6%）（t =7.407，P =0.006）；双侧CDSH患者头颅CT中线偏移距离明显小于单侧CDSH患者，（11.7±2.0）vs（5.5±3.6）mm，差异有统计学意义（t =-10.981，P <0.001）。两组患者在临床表现、术后并发症方面比较差异无统计学意义，在术后3个月及1年死亡率分别为（2.7% vs 4.1%，χ2=0.131，P =1.000）和（6.7%vs8.3%，χ2=0.068，P =1.000），差异无统计学意义；两组患者卡氏评分活动指数术后3个月和术后1年比较，分别为（72.3±11.6 vs 75.3±11.6，t =0.786，P =0.689）、（81.8±9.6 vs 80.5±8.6，t =0.776，P =0.901），差异无统计学意义。结论  双侧CDSH患者年龄偏大，合并糖尿病的概率高，双侧CDSH患者中线偏移距离较单侧的小，临床特点和术后并发症方面两者无差异。

Abstract:

Objective To compare clinical features of unilateral and bilateral chronic subdural hematoma (CSDH), and to provide a reference for clinical treatment. Methods A total of 98 surgical patients with CSDH from May 2009 to December 2015 in the department of neurosurgery of our hospital were collected. The clinical features, precipitating factors, coexistent disease, computed tomography (CT) results, postoperative complications, death case and KPS scores were observed and collected. Results Bilateral CSDH was occurred in 28 (24.5%) of the 98 CSDH patients, the mean age in bilateral CSDH was older than unilateral CSDH, the difference was statistically significant (75.1 ± 3.6) vs (70.1 ± 7.2) y (t = 4.072, P < 0.001). The probability of CDSH patients with diabetes was higher in bilateral CSDH than unilateral CSDH (45.8% vs 17.6%; t = 7.407; P = 0.006). The midline shift of CT in bilateral CSDH was less than unilateral CSDH, the difference was statistically significant (11.7 ± 2.0 mm vs 5.5 ± 3.6 mm; t = -10.981, P < 0.001). The clinical presentation, postoperative complication between two groups showed no significant difference. The rate of mortality had no difference between two groups in 3 months and 1 year after surgery (2.7% vs 4.1%, χ2 = 0.131, P = 1.000; 6.7% vs 8.3%, χ2 = 0.068, P = 1.000). The KPS scores also had no significant difference between two groups in 3 months and 1 year after surgery  [(72.3 ± 11.6 vs 75.3 ± 11.6, t = 0.786, P = 0.689), (81.8 ± 9.6 vs 80.5 ±8.6, t = 0.776, P = 0.901)]. Conclusions Patients suffered bilateral CSDH tends to be older and has a higher rate of diabetes. The midline shift in bilateral CSDH is less than that in unilateral CSDH.