Vychopen Martin, Wach Johannes, Lampmann Tim, Asoglu Harun, Borger Valeri, Hamed Motaz, Vatter Hartmut, Güresir Erdem
Department of Neurosurgery, University Hospital Bonn, 53127 Bonn, Germany.
Brain Sci. 2022 Sep 26;12(10):1298. doi: 10.3390/brainsci12101298.
Introduction: The aim of the study was to analyze risk factors for hematoma expansion (HE) in patients undergoing decompressive hemicraniectomy (DC) in patients with elevated intracranial pressure due to spontaneous intracerebral hematoma (ICH). Methods: We retrospectively evaluated 72 patients with spontaneous ICH who underwent DC at our institution. We compared the pre- and postoperative volumes of ICH and divided the patients into two groups: first, patients with postoperative HE > 6 cm3 (group 1), and second, patients without HE (group 2). Additionally, we screened the medical history for anticoagulant and antiplatelet medication (AC/AP), bleeding-related comorbidities, age, admission Glasgow coma scale and laboratory parameters. Results: The rate of AC/AP medication was higher in group 1 versus group 2 (15/16 vs. 5/38, p < 0.00001), and patients were significantly older in group 1 versus group 2 (65.1 ± 16.2 years vs. 54.4 ± 14.3 years, p = 0.02). Furthermore, preoperative laboratory tests showed lower rates of hematocrit (34.1 ± 5.4% vs. 38.1 ± 5.1%, p = 0.01) and hemoglobin (11.5 ± 1.6 g/dL vs. 13.13 ± 1.8 g/dL, p = 0.0028) in group 1 versus group 2. In multivariate analysis, the history of AC/AP medication was the only independent predictor of HE (p < 0.0001, OR 0.015, CI 95% 0.001−0.153). Conclusion: We presented a comprehensive evaluation of risk factors for hematoma epansion by patients undergoing DC due to ICH.
本研究旨在分析因自发性脑内血肿（ICH）导致颅内压升高而接受减压性颅骨切除术（DC）的患者发生血肿扩大（HE）的危险因素。方法：我们回顾性评估了在我院接受DC的72例自发性ICH患者。我们比较了ICH的术前和术后体积，并将患者分为两组：第一组为术后HE>6 cm³的患者（第1组），第二组为无HE的患者（第2组）。此外，我们筛查了抗凝和抗血小板药物（AC/AP）用药史、出血相关合并症、年龄、入院时格拉斯哥昏迷量表及实验室参数。结果：第1组AC/AP用药率高于第2组（15/16 vs. 5/38，p<0.00001），第1组患者年龄显著大于第2组（65.1±16.2岁 vs. 54.4±14.3岁，p = 0.02）。此外，术前实验室检查显示，第1组的血细胞比容（34.1±5.4% vs. 38.1±5.1%，p = 0.01）和血红蛋白（11.5±1.6 g/dL vs. 13.13±1.8 g/dL，p = 0.0028）率低于第2组。多因素分析中，AC/AP用药史是HE的唯一独立预测因素（p<0.0001，OR 0.015，95%CI 0.001−0.153）。结论：我们对因ICH接受DC的患者血肿扩大的危险因素进行了全面评估。
