目的：探讨重型颅脑损伤患者行开颅手术后发生迟发性颅内血肿的危险因素，以期能够改善患者预后质量。方法选取2010年3月-2014年3月富阳市人民医院收治的行开颅手术治疗的重型颅脑损伤患者102例，依据患者术后是否发生迟发性颅内血肿将其分为迟发组和非迟发组，记录两组患者临床资料，包括性别、年龄、发病至手术时间、颅骨骨折、蛛网膜下腔出血、Babinski 征阳性、基底池受压、血浆凝血酶原时间、活化部分凝血活酶时间、血浆凝血酶时间、格拉斯哥昏迷量表（GCS）评分、收缩压、舒张压、血小板计数、纤维蛋白原、血肿量等。采用多因素 Logistic 回归分析探讨影响患者行开颅手术后发生迟发性颅内血肿的危险因素。结果依据患者术后是否发生迟发性颅内血肿将其分为迟发组41例和非迟发祖61例。两组性别、年龄、蛛网膜下腔出血发生率、血浆凝血酶原时间、收缩压、血小板计数、血肿量比较，差异均无统计学意义（P >0.05）；两组发病至手术时间、颅骨骨折发生率、Babins-ki 征阳性发生率、基底池受压发生率、活化部分凝血活酶时间、血浆凝血酶时间、GCS 评分、舒张压、纤维蛋白原水平比较，差异均有统计学意义（P <0.05）。进一步行多因素 Logistic 回归分析结果显示，发病至手术时间、颅骨骨折、Babinski 征阳性、血浆凝血酶时间是重型颅脑损伤患者行开颅手术后发生迟发性颅内血肿的独立影响因素（P <0.05）。结论对伴随颅骨骨折、Babinski 征阳性、血浆凝血酶时间延长以及发病至手术时间较早等出现发生迟发性颅内血肿的独立危险因素的重型颅脑损伤患者应加强监护并给予早期预防治疗，降低迟发性颅内血肿发生风险。%Objective To explore the risk factors of the delayed intracranial hematoma followed by craniotomy in se-vere head injury patients,in order to improve the quality of prognosis of the patients. Methods Clinical data of 102 cases of se-vere head injury patients who treated with craniotomy in People's Hospital of Fuyang from March 2010 to March 2014 were ana-lyzed retrospectively. They were grouped based on the occurrence of delayed intracranial hematoma. The clinical data were recorded in the two groups,including gender of the patients,age,time from onset to operation,the occurrence of fracture of skull,sub-arachnoid hemorrhage,positive Babinski symptoms,compression of basilar cistern,plasma prothrombin time,activated partial thromboplastin time,plasma thrombin time,GCS score,systolic pressure,diastolic pressure,blood platelet count,fibrinogen and volume of hematoma. Multivariate Logistic regression analysis were used to analyze the risk factors for delayed intracranial he-matoma followed by craniotomy. Results The patients were divided into delayed group(41 cases)and non - delayed group(61 cases). The gender,age,incidence of subarachnoid hemorrhage,plasma prothrombin time,systolic pressure,blood platelet count and volume of hematoma showed no statistically significant difference(P > 0. 05). The time from onset to operation,inci-dence of fracture of skull,incidence of positive Babinski symptoms and compression of basilar cistern,activated partial thrombo-plastin time,plasma thrombin time,GCS score,diastolic pressure and fibrinogen level showed statistically significant differences between the two groups(P < 0. 05). Multivariate Logistic regression analysis showed that the time from onset to operation,frac-ture of skull,positive Babinski symptoms and plasma thrombin time were independent factors for delayed intracranial hematoma followed by craniotomy in severe head injury patients(P < 0. 05). Conclusion The severe head injury patients associated with the risk factors of delayed intracranial hematoma such as skull fracture,positive Babinski symptoms,longer plasma thrombin time,early operation and so on should be given intensive care and preventive treatment in order to reduce the risk of delayed in-tracranial hematoma.
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