颅脑外伤去骨瓣减压术后患者短期内血肿扩大或新发出血的危险因素分析

Analysis of risk factors for short-term hematoma enlargement or new-onset hemorrhage after decompressive craniectomy in patients with traumatic brain injury

摘要:

目的 通过头部CT图像探讨脑外伤患者行去骨瓣减压术后短期血肿扩大或新发出血的危险因素，提高预测血肿扩大或新发出血的准确率。方法 回顾性分析2016年12月-2019年6月在中国人民解放军北部战区总医院行去骨瓣减压术治疗的197例脑外伤患者的临床资料和治疗前后的头部CT检查图像。通过CT检查图像确定患者术前是否伴有中线移位、硬膜外血肿、硬膜下血肿等体征，计算手术前后血肿量。单因素分析血肿扩大或新发出血的影响因素，多因素Logistic回归分析血肿扩大或新发出血的独立危险因素，最后采用ROC曲线评估诊断价值。结果 是否有术前伴硬膜下血肿、不同术前血肿量患者的新发出血或出血扩大率比较，差异有统计学意义（P <0.05）。多因素Logistic分析结果显示：术前伴硬膜下血肿［R=13.563（95% CI=5.325，34.549）］和术前血肿量≥20 cm3［R=26.649（95% CI：10.436，68.047）］是术后血肿扩大或新发出血的独立危险因素。术前伴有硬膜下血肿曲线下面积为0.788（95%CI：0.722，0.854），敏感性为88.70%（95% CI：0.820，0.954），特异性为69.00%（95% CI：0.623，0.757）。术前血肿量≥20 cm3的曲线下面积为0.839（95% CI：0.779，0.898），敏感性为90.70%（95% CI：0.8482，0.966），特异性位77.00%（95% CI：0.711，0.829）。两者联合曲线下面积为0.914（95% CI：0.872，0.957），敏感性为90.03%（95% CI：0.857，0.943），特异性为75.33%（95% CI：0.710，0.796）。结论 术前伴硬膜下血肿和术前血肿量≥20 cm3对脑外伤患者行去骨瓣减压术后短期血肿扩大或新发出血有预测价值，两者联合具有有较高的预测价值。

Abstract:

Objective To explore the risk factors of short-term hematoma enlargement or new-onset hemorrhage after decompressive craniectomy in patients with traumatic brain injury via cranial computed tomography (CT), and to improve the accuracy of predicting hematoma enlargement or new-onset hemorrhage.Methods Retrospective analysis was performed on the clinical data and cranial CT images of 197 patients with traumatic brain injury who received decompressive craniectomy in the General Hospital of Northern Theater Command from December 2016 to June 2019. The CT images were used to determine whether the patients were accompanied by midline shift, epidural hematoma, subdural hematoma and other signs before surgery, and the hematoma volume before and after surgery was calculated. Univariate analysis and multivariate Logistic analysis were applied to identify influencing factors or independent risk factors of hematoma enlargement and new-onset hemorrhage, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive values of these potential indicators.Results The incidences of hematoma enlargement and new-onset hemorrhage were significantly different in patients with or without subdural hematoma and those with different hematoma volume before surgery (P < 0.05). Multivariate Logistic analysis showed that preoperative subdural hematoma [R = 13.563 (95% CI: 5.325, 34.549)] and preoperative hematoma volume ≥20 cm3 [R = 26.649 (95% CI: 10.436, 68.047)] were independent risk factors for postoperative hematoma enlargement or new-onset hemorrhage (P < 0.05). For predicting the hematoma enlargement and new-onset hemorrhage, the area under the ROC curve (AUC) of preoperative subdural hematoma was 0.788 (95% CI: 0.722, 0.854), with the sensitivity being 88.70% (95 CI%: 82.03%, 95.36%) and the specificity being 69.00% (95% CI: 62.33%, 75.66%); the AUC of preoperative hematoma volume ≥ 20 cm3 was 0.839 (95% CI: 0.779, 0.898), showing a sensitivity of 90.70% (95% CI: 84.82%, 96.58%) and a specificity of 77.00% (95% CI: 71.12%, 82.88%). The combination of the two indicators yielded an increase in AUC to 0.914 (95% CI: 0.872, 0.957), with the sensitivity being 90.03% (95% CI: 85.71%, 94.34%) and the specificity being 75.33% (95% CI: 71.01%, 79.64%).Conclusions Preoperative subdural hematoma and preoperative hematoma volume ≥ 20 cm3 exhibit predictive values for short-term hematoma enlargement or new-onset hemorrhage after decompressive craniectomy in patients with traumatic brain injury, and the combination of the two further improves the predictive value.