Abouzari Mehdi, Rashidi Armin, Rezaii Jalal, Esfandiari Khalil, Asadollahi Marjan, Aleali Hamideh, Abdollahzadeh Mehdi
Amir-Alam Hospital, Department of Medical Sciences, University of Tehran, Tehran, Iran.
Neurosurgery. 2007 Oct;61(4):794-7; discussion 797. doi: 10.1227/01.NEU.0000298908.94129.67.
Chronic subdural hematoma (CSDH) is one of the most common types of intracranial hemorrhage, especially in the elderly, with a significant recurrence rate ranging from 9.2 to 26.5%. The role of postoperative patient posture in the recurrence of CSDH has not been studied sufficiently.
A total of 84 consecutive patients with unilateral traumatic CSDH without known risk factors of CSDH recurrence were prospectively enrolled in this study. All patients underwent burr-hole surgery with closed system drainage and were then allocated randomly to either of two groups: Group A (n = 42) patients were kept in a supine position for 3 days after the operation, whereas Group B (n = 42) patients assumed a sitting position in bed, with the head of the bed elevated to 30 to 40 degrees, for the same duration as Group A. After 3 days, there was no restriction in patients' activities in both groups. All patients were followed-up for at least 3 months after surgery.
The groups were not significantly different in age, sex, presence of brain atrophy or hydrocephalus, preoperative hematoma width, and postsurgery subdural space width. The recurrence rate in Groups A and B were 2.3 and 19.0% (necessitating repeat surgery in one patient), respectively (P = 0.02). Other complications in Groups A and B, respectively, were atelectasis (10 versus seven; P = 0.41), pneumonia (five versus four; P = 0.72), decubitus ulcer (three versus two; P = 0.64), and deep vein thrombosis (zero versus one; P = 0.31).
Assuming an upright posture soon after burr-hole surgery was associated with a significantly increased incidence of CSDH recurrence but not with a significant change in other position-related postsurgical complications. According to this result, it is not recommended that elderly patients assume an upright posture soon after burr-hole surgery to prevent postoperative atelectasis and dementia, as these might significantly increase the risk of CSDH recurrence.
慢性硬膜下血肿（CSDH）是最常见的颅内出血类型之一，尤其在老年人中，复发率高达9.2%至26.5%。术后患者体位对CSDH复发的影响尚未得到充分研究。
本研究前瞻性纳入了84例连续的单侧外伤性CSDH患者，这些患者无已知的CSDH复发风险因素。所有患者均接受了钻孔手术及闭式引流，然后随机分为两组：A组（n = 42）患者术后保持仰卧位3天，而B组（n = 42）患者在床上采取坐位，床头抬高30至40度，持续时间与A组相同。3天后，两组患者的活动均无限制。所有患者术后至少随访3个月。
两组在年龄、性别、脑萎缩或脑积水情况、术前血肿宽度及术后硬膜下腔宽度方面无显著差异。A组和B组的复发率分别为2.3%和19.0%（1例患者需要再次手术）（P = 0.02）。A组和B组的其他并发症分别为肺不张（10例对7例；P = 0.41）、肺炎（5例对4例；P = 0.72）、压疮（3例对2例；P = 0.64）和深静脉血栓形成（0例对1例；P = 0.31）。
钻孔手术后立即采取直立位与CSDH复发率显著增加相关，但与其他体位相关的术后并发症无显著变化。根据这一结果，不建议老年患者在钻孔手术后立即采取直立位以预防术后肺不张和痴呆，因为这可能会显著增加CSDH复发的风险。
