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中华神经创伤外科电子杂志 ›› 2021, Vol. 07 ›› Issue (06) : 359 -363. doi: 10.3877/cma.j.issn.2095-9141.2021.06.008

临床研究

单侧慢性硬膜下血肿患者术后复发的预测因素分析
王如海1, 胡海成1,(), 韩超1, 于强1, 黄好峰1   
  1. 1. 236063 安徽阜阳,阜阳市第五人民医院神经外科
  • 收稿日期:2021-03-05 出版日期:2021-12-15
  • 通信作者: 胡海成

Analysis of the predictive factors of postoperative recurrence in patients with unilateral chronic subdural hematoma

Ruhai Wang1, Haicheng Hu1,(), Chao Han1, Qiang Yu1, Haofeng Huang1   

  1. 1. Department of Neurosurgery, Fuyang Fifth People’s Hospital, Fuyang 236063, China
  • Received:2021-03-05 Published:2021-12-15
  • Corresponding author: Haicheng Hu
引用本文:

王如海, 胡海成, 韩超, 于强, 黄好峰. 单侧慢性硬膜下血肿患者术后复发的预测因素分析[J/OL]. 中华神经创伤外科电子杂志, 2021, 07(06): 359-363.

Ruhai Wang, Haicheng Hu, Chao Han, Qiang Yu, Haofeng Huang. Analysis of the predictive factors of postoperative recurrence in patients with unilateral chronic subdural hematoma[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(06): 359-363.

目的

探究单侧慢性硬膜下血肿(CSDH)患者术后复发的危险因素及预测价值。

方法

回顾分析阜阳市第五人民医院神经外科自2017年12月至2020年8月收治的108例行手术治疗的单侧CSDH患者的临床资料。根据术后3个月患者CSDH复发情况,将患者分为复发组(13例)及未复发组(95例)。采用单因素和多因素Logistic回归分析CSDH患者术后复发的危险因素,采用受试者特征工作曲线(ROC)分析危险因素对复发的预测价值。

结果

单因素和多因素Logistic回归分析结果显示,术后7 d硬膜下间隙宽度(OR=1.336,95%CI:1.126~1.585,P=0.001)、术前血肿最大CT值(OR=1.221,95%CI:1.071~1.393,P=0.003)是患者术后复发的危险因素。上述独立危险因素的曲线下面积(AUC)分别为0.806(95%CI:0.781~0.876,P<0.001)及0.738(95%CI:0.645~0.818,P<0.001),二者联合预测复发的AUC为0.904(95%CI:0.832~0.952,P<0.001)。

结论

术后7 d硬膜下间隙宽度、术前血肿最大CT值为单侧CSDH术后复发的独立危险因素,二者联合应用对术后血肿复发具有较好的预测价值。

Objective

To explore risk factors and predictive value of postoperative recurrence in patients with unilateral chronic subdural hematoma (CSDH).

Methods

Clinical data of 108 patients with unilateral CSDH admitted to Neurosurgery Department of Fuyang Fifth People’s Hospital from December 2017 to August 2020 were retrospectively analyzed. According to the CSDH recurrence within 3 months after operation, the patients were divided into the group of recurrence (n=13) and the group of non-recurrence (n=95). Univariate and multivariate binary Logistic regression analysis were applied to analyze the independent risk factors of recurrence. The receiver operating characteristic (ROC) curve was used to investigate the predictive value of the risk factors.

Results

Multivariate binary logistic regression analysis showed that ipsilateral width of subdural space at 7th day after operation (OR=1.336, 95%CI: 1.126-1.585, P=0.001), maximum CT value of hematoma (OR=1.221, 95%CI: 1.071-1.393, P=0.003) was independently correlated with recurrence. The area under the curve (AUC) of those independent risk factors were 0.806 (95%CI: 0.781-0.876, P<0.001) and 0.738 (95%CI: 0.645-0.818, P<0.001), respectively. The AUC of the risk factors combined to predict recurrence was 0.904 (95%CI: 0.832-0.952, P<0.001).

Conclusion

The width of subdural space at 7th day after operation and the maximum CT value of hematoma are independent risk factors for the recurrence of unilateral CSDH, the combined application of the two has a good predictive value for the recurrence of postoperative hematoma

表1 慢性硬膜下血肿患者术后复发的单因素分析
图1 慢性硬膜下血肿患者术前术后影像学资料A:术前头颅CT示混合密度血肿;B:术后7 d复查头颅CT示较大的硬膜下间隙宽度;C:术后患者反应逐渐变迟钝,临床症状重现,复查CT示血肿复发;D:血肿复发再次手术术后CT影像
表2 慢性硬膜下血肿术后复发的多因素Logistics回归分析
表3 危险因素预测慢性硬膜下血肿术后复发的曲线下面积
图2 不同因素对复发的预测能力的受试者特征工作曲线
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