摘要：
目的 探讨慢性硬膜下血肿患者钻孔引流术后复发的相关危险因素.方法 回顾性分析2013年1月至2016年12月厦门大学附属中山医院神经外科收治的142例慢性硬膜下血肿患者的临床资料.先后采用单因素(卡方检验)和多因素(logistic回归分析)分析慢性硬膜下血肿术后复发的危险因素.结果 142例患者术后随访时间为3～24个月,其中有21例患者术后出现血肿复发,复发率为14.8％.术后并发症包括:癫痫4例,颅内感染2例,硬膜下积液10例,颅内血肿1例,非张力性气颅23例.单因素分析结果显示,慢性硬膜下血肿患者术后复发的危险因素包括:年龄、术前服用抗凝药物、术前血肿宽度、术前中线移位及术后硬膜下间隙(均P<0.05).多因素logistic回归分析结果显示,年龄(OR=20.914,95％CI:3.451～126.741)、术前服用抗凝药物(OR=10.679,95％CI:1.873～60.880)、术前血肿宽度(OR=3.602,95％CI:1.029-12.611)及术前中线移位(OR=4.613,95％CI:1.222～17.418)与患者术后复发密切相关(均P<0.05).结论 慢性硬膜下血肿术后复发与多种因素有关,年龄(≥70岁)、术前服用抗凝药物、术前血肿宽度(≥20 mm)以及术前中线移位(≥10 mm)是术后复发的独立危险因素.%Objective To explore the risk factors of recurrence of chronic subdural hematoma after drilling and drainage. Methods Clinical data of 142 patients with chronic subdural hematoma admitted to Department of Neurosurgery, Zhongshan Hospital, Xiamen University from January 2013 to December 2016 were collected and retrospectively analyzed. Univariate ( chi-square test ) and multivariate ( logistic regression test ) were used to analyze the risk factors for postoperative recurrence of chronic subdural hematoma. Results The postoperative follow-up period of 142 patients was 3 to 24 months. Among them, 21 patients had hematoma after operation and the recurrence rate was 14. 8％. Postoperative complications included 4 cases of epilepsy, 2 cases of intracranial infection, 10 cases of subdural effusion, 1 case of intracranial hematoma, and 23 cases of atonic pneumocephalus. Univariate analysis demonstrated that age of onset, anticoagulation, preoperative width of hematoma, preoperative midline shift and postoperative width of subdural space were associated with postoperative recurrence of chronic subdural hematoma (all P<0. 05). Multivariate analysis showed that age ( OR = 20. 914, 95％ CI: 3. 451 - 126. 741 ), preoperative anticoagulant medication (OR =10. 679, 95％CI: 1. 873 -60. 880), preoperative width of hematoma (OR=3. 602, 95％CI:1. 029-12. 611) and preoperative midline shift (OR=4. 613, 95％CI:1. 222-17. 418 ) were significantly associated with postoperative recurrence. Conclusions The postoperative recurrence in patients with chronic subdural hematoma is related to multiple factors. Age ≥70 years, preoperative anticoagulation, preoperative width of hematoma ≥20 mm and preoperative midline shift ≥10 mm were independent risk factors for postoperative recurrence of chronic subdural hemotoma.
