The Correlative Analysis Of The Prognosis And Bilateral Hemorrhage Of Chronic Subdural Hematoma

Objective 1.To analyze and select the related factors that influence the prognosis of chronic subdural hematoma after burr-hole drainage. 2.To explore the possible risk factors related to bilateral bleeding of chronic subdural hematoma;Methods A retrospective chart review was performed on patients underwent burr-hole drainage for chronic subdural hematoma at the Neurosurgical Department of the Renji Hospital,affiliated to Shanghai Jiaotong University School of Medicine from January 1^st 2014 to January 1^st 2017,including 440 patients.Clinical data,including medical history,signs,blood coagulation function and imaging examination was collected.Medical history was comprised of age,sex,course of the disease,trauma history,clinical symptoms,basic diseases,anesthesia patterns and history of medication of antiplatelet or anticoagulant drugs.Imaging examination results were comprised of hematoma location,the density of hematoma,the thickness of hematoma cavity,the distance of midline structure shift and intracranial gas volume on the first post-surgery day.Blood coagulation function test included prothrombin time,thrombin time,activated partial prothrombin time,international standardization ratio and the platelet count.Logistic regression analysis were performed to assess the relationships between various variables and the prognosis,univariate analysis and multivariate logistic regression analysis were performed to explore the risk factors that lead to the occurrence of bilateral bleeding.Results The pre-and post-surgery neurological functional grades of the 440patients that underwent burr-hole drainage were assessed by the Markwalder system.The decrease of Markwalder grade was regarded as improvement and the overall improvement rate was 90.9%?Univariate analysis of the prognosis of CSDH indicated that the P values of age,medication history with or without antiplatelet or anticoagulant drugs,bilateral bleeding or not,thickness of hematoma cavity,intracranial gas volume on the first post-surgery day,preoperative Markwalder grade were0.039,0.023,0.034,0.047,0.029.0.027.These factors were considered to be associated with the prognosis.Mutivariate analysis revealed that the P value of medication history with or without antiplatelet or anticoagulant drugs was 0.044,and the OR was more than 1.Therefore,it was considered that the prognosis of patients without antiplatelet or anticoagulant drugs was better than those users.And the P value of preoperative Markwalder grade was 0.037,and the OR was less than 1.Therefore,it was considered that the lower the preoperative Markwalder grade,the better the prognosis.Single factor analysis of the influencing factors of bilateral hemorrhage indicated that the P values of age,medication history of antiplatelet or anticoagulant drugs,TT were respectively 0.046,0.038,0.040.These factors were considered to be associated with bilateral bleeding.Multi-factor analysis revealed that the P value of TT was 0.042 and OR was more than 1,so TT was the independent risk factor of bilateral bleeding of chronic subdural hemorrhage.Conclusions 1.The factors,age and medication history of antiplatelet or anticoagulant drugs,were closely related to bilateral hemorrhage in chronic subdural hematoma; 2.The lower the preoperative Markwalder grade,the lower the postoperative.3.The prognosis of patients without antiplatelet or anticoagulant drugs is better than those users.