Analysis Of Influencing Factors And Prognosis Of Contralateral Delayed Intracranial Hematoma After Unilateral Deboning Decompression Of Severe Head Injury

Objective: To explore the related influencing factors of contralateral delayed traumatic intracranial hematoma(DTICH)in patients with severe traumatic brain injury(sTBI)after unilateral Large decompressive craniectomy(LDC),and to summarize the clinical characteristics of delayed intracranial hematoma.And analyze the impact on the short-term prognosis of patients,and improve the understanding of the risk factors of delayed intracranial hematoma.Through the early prediction of DTICH,in order to ensure the survival rate of patients after surgical intervention,improve the treatment effect of patients with severe brain injury,and provide theoretical basis for clinical prevention and treatment.Methods: The clinical cases of severe traumatic brain injury and unilateral deboning decompression were diagnosed in the Department of Neurosurgery of Hebei University Hospital from January 2016 to January 2019.The collected cases were then grouped according to whether the contralateral delayed traumatic intracranial hematoma(DTICH)occurred after surgery as a standard: the case group(contralateral delayed intracranial hematoma occurred,n = 35),and the control group(not occurred Contralateral delayed intracranial hematoma,n = 79).Relevant clinical data were collected from two groups of patients to summarize the clinical characteristics of DTICH.At the same time,the Glasgow coma score,pupil changes,preoperative lesion classification,Rotterdam CT score,injury distance to surgery time,and Glasgow outcome scale were compared and analyzed.Result:1.Among the 114 patients in this study,35 cases of contralateral delayed intracranial hematoma occurred after deboning flap decompression,and the incidence rate was 30.7%.2.The univariate analysis was performed on the data of relevant influencing factors of 114 patients participating in the project.Independent sample t-test,chi-square test,and rank sum test were used.The results showed: patient age,preoperative Rotterdam CT score,preoperative lesion classification,and merger skull fractures,combined contralateral skull fractures,and injury distance surgery time were related to the occurrence of contralateral delayed intracranial hematoma after decompressive flap decompression in patients with severe head injury(P <0.05).Two groups of patients in the gender,midline shift,preoperative pupil change,combined history of hypertension and diabetes,preoperative Glasgow coma score,trauma type,operation time,red blood cell count,white blood cell count,platelet count,hemoglobin value,random blood glucose,prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),and international standardized ratio(INR)were not correlations.The results were not statistically significant(P> 0.05).3.According to the univariate analysis results,statistically significant factors and indicators that are professionally considered to have an impact on outcomes were included in the multivariate logistic regression model.The results showed that age [OR = 1.060,95% CI(1.010,1.112)],combined Contralateral skull fracture [OR = 25.297,95% CI(4.629,138.229)] and preoperative Rotterdam CT score [OR = 6.733,95% CI(1.360,33.342)] were independent risk factors for contralateral delayed intracranial hematoma in patients with severe traumatic brain injury after unilateral decompression of bone flap(P<0.05).The time from injury to operation [OR=0.959,95%ci(0.922,0.999)] was a protective factor for the occurrence of contralateral delayed intracranial hematoma in patients with severe traumatic brain injury after unilateral decompression of bone flap.4.By comparing the Glasgow outcome score(GOS)of the patients in the two groups at 3 months after surgery,the case group: 1 patient recovered well(2.9%),3 patients with moderate disability(8.6%),11 patients with severe disability(31.4%),16 patients with plant survival(45.7%),and 4 patients with death(11.4%);control group: 13 patients(16.5%)with good recovery,18 with moderate disability(22.8%),31 with severe disability(39.2%),10 with plant survival(12.7%)and 7 with death(8.9%).Statistical analysis showed that the prognosis of the control group was significantly better than that of the case group,and the difference was statistically significant(Z = 3.668,P <0.05).Conclusion:1.Patient age,contralateral skull fracture combined with surgery,and Rotterdam CT score before surgery were independent risk factors of contralateral delayed intracranial hematoma after decompression of unilateral deboned flap in severe traumatic brain injury.2.The time from injury to operation was a protective factor for the occurrence of contralateral delayed intracranial hematoma in patients with severe traumatic brain injury after unilateral decompression.3.Contralateral delayed intracranial hematoma after unilateral deboning flap decompression of severe traumatic brain injury severely affects the prognosis of patients and increases the mortality and disability rate after surgery.4.There are risk factors such as old age,high preoperative Rotterdam CT score,contralateral skull fracture combined with surgery,short time between injury and surgery,which should be taken seriously in clinical practice and be alert to the occurrence of delayed intracranial hematoma.