Jian M, Li X, Wang A, Zhang L, Han R, Gelb A W
Department of Anaesthesiology, Beijing Tiantan Hospital, Capital Medical University, No. 6 Tiantan Xili, Beijing 100050, China.
Department of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Capital Medical University, Beijing, China.
Br J Anaesth. 2014 Nov;113(5):832-9. doi: 10.1093/bja/aeu185. Epub 2014 Jun 25.
Post-craniotomy intracranial haematoma is one of the most serious complications after neurosurgery. We examined whether post-craniotomy intracranial haematoma requiring surgery is associated with the non-steroidal anti-inflammatory drugs flurbiprofen, hypertension, or hydroxyethyl starch (HES).
A case-control study was conducted among 42 359 patients who underwent elective craniotomy procedures at Beijing Tiantan Hospital between January 2006 and December 2011. A one-to-one control group without post-craniotomy intracranial haematoma was selected matched by age, pathologic diagnosis, tumour location, and surgeon. Perioperative blood pressure records up to the diagnosis of haematoma, the use of flurbiprofen and HES were examined. The incidence of post-craniotomy intracranial haematoma and the odds ratios for the risk factors were determined.
A total of 202 patients suffered post-craniotomy intracranial haematoma during the study period, for an incidence of 0.48% (95% CI=0.41-0.55). Haematoma requiring surgery was associated with an intraoperative systolic blood pressure of >160 mm Hg (OR=2.618, 95% CI=2.084-2.723, P=0.007), an intraoperative mean blood pressure of >110 mm Hg (OR=2.600, 95% CI=2.312-3.098, P=0.037), a postoperative systolic blood pressure of >160 mm Hg (OR=2.060, 95% CI= 1.763-2.642, P=0.022), a postoperative mean blood pressure of >110 mm Hg (OR=3.600, 95% CI= 3.226-4.057, P=0.001), and the use of flurbiprofen during but not after the surgery (OR=2.256, 95% CI=2.004-2.598, P=0.005). The intraoperative infusion of HES showed no significant difference between patients who had a haematoma and those who did not.
Intraoperative and postoperative hypertension and the use of flurbiprofen during surgery are risk factors for post-craniotomy intracranial haematoma requiring surgery. The intraoperative infusion of HES was not associated with a higher incidence of haematoma.
开颅术后颅内血肿是神经外科手术后最严重的并发症之一。我们研究了需要手术治疗的开颅术后颅内血肿是否与非甾体类抗炎药氟比洛芬、高血压或羟乙基淀粉（HES）有关。
对2006年1月至2011年12月在北京天坛医院接受择期开颅手术的42359例患者进行了一项病例对照研究。选择一组无开颅术后颅内血肿的一对一对照组，根据年龄、病理诊断、肿瘤位置和手术医生进行匹配。检查直至血肿诊断时的围手术期血压记录、氟比洛芬和HES的使用情况。确定开颅术后颅内血肿的发生率及危险因素的比值比。
在研究期间，共有202例患者发生开颅术后颅内血肿，发生率为0.48%（95%CI=0.41-0.55）。需要手术的血肿与术中收缩压>160mmHg（OR=2.618，95%CI=2.084-2.723，P=0.007）、术中平均血压>110mmHg（OR=2.600，95%CI=2.312-3.098，P=0.037）、术后收缩压>160mmHg（OR=2.060，95%CI=1.763-2.642，P=0.022）、术后平均血压>110mmHg（OR=3.600，95%CI=3.226-4.057，P=0.001）以及手术期间而非术后使用氟比洛芬（OR=2.256，95%CI=2.004-2.598，P=0.00)有关。术中输注HES在有血肿和无血肿的患者之间无显著差异。
术中和术后高血压以及手术期间使用氟比洛芬是需要手术的开颅术后颅内血肿的危险因素。术中输注HES与较高的血肿发生率无关。
