Department of Neurosurgery, Goethe University Frankfurt am Main, Schleusenweg 2-16, D-60528 Frankfurt am Main, Germany.
J Clin Neurosci. 2010 Aug;17(8):975-9. doi: 10.1016/j.jocn.2009.11.023. Epub 2010 May 23.
The main aim of this study was to investigate the influence of perioperative anticoagulation on the clinical course and outcome of 144 patients who underwent surgery for chronic subdural hematoma (CSDH). The outcome was categorized according to the modified Rankin Scale (mRS), Barthel Index and postoperative quality of life (QoL) scale. There was a significant correlation between preoperative aspirin medication and reoperation (Mann-Whitney U-test, p<0.05). Moreover, dosage and duration of postoperative low-molecular-weight heparin (LMWH) administration were associated with a higher risk of reoperation (Mann-Whitney U-test, p<0.01) and a worse outcome on the mRS (Mann-Whitney U-test, p<0.05). Intraoperative treatment with prothrombin complex concentrate led to a poor outcome on the mRS (Craddock-Flood test, p<0.05). Reoperation is the strongest predictive factor of a poor QoL after surgical treatment of CSDH. Both preoperative and postoperative anticoagulation treatment may affect reoperation rate and, thus, postoperative QoL.
本研究的主要目的是探讨围手术期抗凝对 144 例行慢性硬脑膜下血肿（CSDH）手术患者的临床病程和结局的影响。根据改良 Rankin 量表（mRS）、巴氏指数和术后生活质量（QoL）量表对结果进行分类。术前阿司匹林用药与再次手术之间存在显著相关性（Mann-Whitney U 检验，p<0.05）。此外，术后低分子肝素（LMWH）的剂量和使用时间与再次手术的风险增加（Mann-Whitney U 检验，p<0.01）以及 mRS 评分较差相关（Mann-Whitney U 检验，p<0.05）。术中使用凝血酶原复合物浓缩物会导致 mRS 评分较差（Craddock-Flood 检验，p<0.05）。再次手术是 CSDH 手术后生活质量较差的最强预测因素。术前和术后抗凝治疗都可能影响再次手术率，进而影响术后生活质量。
