Chen Sansong, Peng Hui, Shao Xuefei, Yao Lin, Liu Jie, Tian Jiongping, Sun Lean, Dai Yi, Jiang Xiaochun, Cheng Limin
Department of Neurosurgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu 241001, Anhui, People's Republic of China.
Administration Office of Hospital Admission and Discharge, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital), Wuhu 241001, Anhui, People's Republic of China.
Neuropsychiatr Dis Treat. 2020 Apr 9;16:943-948. doi: 10.2147/NDT.S245857. eCollection 2020.
To explore the risk factors of the evolution of traumatic subdural effusion (TSE) into chronic subdural hematoma (CSDH).
The 70 patients' gender, age, location of effusion, unilateral and bilateral, Glasgow coma score (GCS) at admission, presence or absence of brain contusion, the time of effusion appeared, daily amount of mannitol, mannitol number of days used, with or without atorvastatin calcium tablets, with or without antiplatelet aggregation drugs, with or without anticoagulant drugs, with or without abnormalities in blood coagulation routines, computed tomography (CT) layer height, the thickness, and CT value of the first effusion were analyzed by single factor. Logistic multivariate regression analysis was performed on the statistically significant indicators. Power of the regression model was evaluated using receiver operating characteristic (ROC) curve.
Univariate analysis showed that the presence or absence of brain contusion, the time of effusion appeared, atorvastatin calcium tablets use or not, the CT value of the effusion, and TSE into CSDH evolution varied significantly compared to the non-evolved group (P<0.05). Logistic multivariate regression analysis showed that combined brain contusion (odds ratio (OR)=16.247, 95% confidence interval (CI), 1.831-144.157, P = 0.012), early onset of effusion (OR = 0.573, 95% CI: 0.349-0.941, P = 0.028), atorvastatin calcium tablets not used after effusion (OR = 60.028, 95% CI: 6.103-590.399, P = 0.0001), and high CT value (OR = 1.285, 95% CI: 1.067-1.547, P = 0.008) were risk factors for the evolution of TSE into CSDH. The ROC model suggested that the prediction of these risk factors had high diagnostic accuracy.
TSE patients with brain contusion, early onset of effusion, without the usage of atorvastatin calcium tablets after effusion, and high CT value of the first effusion are at a risk of evolving into CSDH.
探讨创伤性硬膜下积液（TSE）演变为慢性硬膜下血肿（CSDH）的危险因素。
对70例患者的性别、年龄、积液部位、单侧或双侧、入院时格拉斯哥昏迷评分（GCS）、有无脑挫伤、积液出现时间、甘露醇每日用量、甘露醇使用天数、有无服用阿托伐他汀钙片、有无使用抗血小板聚集药物、有无使用抗凝药物、凝血常规有无异常、计算机断层扫描（CT）层厚、首次积液厚度及CT值进行单因素分析。对有统计学意义的指标进行Logistic多因素回归分析。采用受试者工作特征（ROC）曲线评估回归模型的效能。
单因素分析显示，与未演变组相比，有无脑挫伤、积液出现时间、是否使用阿托伐他汀钙片、积液CT值以及TSE演变为CSDH的情况差异有统计学意义（P<0.05）。Logistic多因素回归分析显示，合并脑挫伤（比值比（OR）=16.247，95%置信区间（CI），1.831 - 144.157，P = 0.012）、积液早期出现（OR = 0.573，95%CI：0.349 - 0.941，P = 0.028）、积液后未使用阿托伐他汀钙片（OR = 60.028，95%CI：6.103 - 590.399，P = 0.0001）以及高CT值（OR = 1.285，95%CI：1.067 - 1.547，P = 0.008）是TSE演变为CSDH的危险因素。ROC模型提示这些危险因素的预测具有较高的诊断准确性。
有脑挫伤、积液早期出现、积液后未使用阿托伐他汀钙片且首次积液CT值高的TSE患者有演变为CSDH的风险。
