Department of Neurosurgery, The Third Affiliated Hospital of Soochow University, No.185, Juqian Road, Changzhou, 213003, China.
BMC Surg. 2022 May 14;22(1):187. doi: 10.1186/s12893-022-01637-5.
The purpose of this retrospective study was to investigate the risk factors for intraoperative acute diffuse brain swelling in patients with isolated traumatic acute subdural haematomas (ASDH).
A total of 256 patients who underwent decompressive craniectomy for isolated traumatic ASDH between April 2013 and December 2020 were included. We evaluated the risk factors for intraoperative acute diffuse brain swelling using a multivariate logistic regression analysis.
The incidence of intraoperative acute diffuse brain swelling in patients with isolated traumatic ASDH was 21.88% (56/256). Dilated pupils (OR = 24.78), subarachnoid haemorrhage (OR = 2.41), and the time from injury to surgery (OR = 0.32) were independent risk factors for intraoperative acute diffuse brain swelling, while no independent associations were observed between these risk factors and sex, age, the mechanism of injury, the Glasgow Coma Scale score, site of haematoma, thickness of haematoma, midline shift and the status of the basal cistern, although the mechanism of injury, the Glasgow Coma Scale score and the status of the basal cistern were correlated with the incidence of intraoperative acute diffuse brain swelling in the univariate analyses.
This study identified the risk factors for intraoperative acute diffuse brain swelling in patients with isolated traumatic ASDH. An increased risk of intraoperative acute diffuse brain swelling occurs in patients with bilaterally dilated pupils, subarachnoid haemorrhage and a shorter time from injury to surgery. These findings should help neurosurgeons obtain information before surgery about intraoperative acute diffuse brain swelling in patients with isolated traumatic ASDH.
本回顾性研究旨在探讨单纯外伤性急性硬膜下血肿（ASDH）患者术中急性弥漫性脑肿胀的危险因素。
纳入 2013 年 4 月至 2020 年 12 月期间因单纯外伤性 ASDH 而行去骨瓣减压术的 256 例患者。我们采用多因素 logistic 回归分析评估术中急性弥漫性脑肿胀的危险因素。
单纯外伤性 ASDH 患者术中急性弥漫性脑肿胀的发生率为 21.88%（56/256）。瞳孔扩大（OR=24.78）、蛛网膜下腔出血（OR=2.41）和受伤至手术的时间（OR=0.32）是术中急性弥漫性脑肿胀的独立危险因素，而这些危险因素与性别、年龄、受伤机制、格拉斯哥昏迷评分、血肿部位、血肿厚度、中线移位和基底池状态之间均无独立相关性，尽管在单因素分析中，受伤机制、格拉斯哥昏迷评分和基底池状态与术中急性弥漫性脑肿胀的发生率相关。
本研究确定了单纯外伤性 ASDH 患者术中急性弥漫性脑肿胀的危险因素。双侧瞳孔扩大、蛛网膜下腔出血和受伤至手术时间较短的患者，术中发生急性弥漫性脑肿胀的风险增加。这些发现有助于神经外科医生在术前获得关于单纯外伤性 ASDH 患者术中急性弥漫性脑肿胀的信息。
