Analysis of risk factors and prognosis of postoperative hematoma enlargement in patients with craniocerebral trauma in plateau areas
Objective To explore the risk factors for postoperative hematoma enlargement in patients with craniocerebral trauma in plateau areas and to analyze their outcomes.Methods A retrospective analysis was performed on the clinical data of 353 patients of craniocerebral trauma in plateau areas who were admitted to the Department of Neurosurgery of Southern Central Hospital of Yunnan Province(331 cases)and the Department of Neurosurgery of the PLA 956th Hospital(22 cases)and underwent surgical treatment from May 2019 to January 2023.According to the changes in hematoma volume shown in the CT examination results within 3 days after surgery,the patients were divided into a hematoma enlargement group and a hematoma non-enlargement group.The clinical data of the patients were collected,including whether there were multiple intracranial hematomas,Sylvian hemorrhage,skull fractures,midline shifts,serum hemoglobin levels,admission blood pressure,admission Glasgow Coma Scale(GCS),serum platelet count,combined underlying diseases,and blood glucose level and other conditions.Univariate analysis and multivariate logistic regression model were used to explore the factors that may affect the expansion of postoperative hematoma in patients with craniocerebral trauma.The modified Glasgow Outcome Score(GOS)was used to evaluate the patient's outcome at discharge,and the rate of good recovery(GOS ≥ 4 points)between the two groups was compared.Kaplan-Meier survival curves were drawn,and the outcome at discharge between the two groups was compared using the log-rank test.Results Among the 353 patients,34(9.63％)were in the hematoma enlargement group and 319(90.37％)were in the hematoma non-enlargement group.Compared with the hematoma non-enlargement group,the hematoma enlargement group had a higher proportion of patients with Sylvian hemorrhage and multiple intracranial hematomas,lower GCS on admission,greater midline shift distance,and higher systolic blood pressure(all P＜0.05).However,there were no statistically significant differences in gender,age,nationality,whether there were underlying diseases,skull fracture,epidural hematoma,serum platelet count,blood glucose level,hemoglobin,or diastolic blood pressure(all P＞0.05).The results of multivariate logistic regression model analysis showed that there was significant midline shift(OR=0.34,95％CI:0.17-0.68,P=0.002)and the presence of Sylvian hemorrhage(OR=2.16,95％CI:1.06-4.41,P=0.035),multiple intracranial hematomas(OR=4.72,95％CI:2.21-10.05,P＜0.001),lower admission GCS(OR=1.20,95％CI:1.09-1.33,P＜0.001)and high systolic blood pressure at admission(OR=0.99,95％CI:0.98-1.00,P=0.030)were risk factors for postoperative hematoma enlargement in patients with craniocerebral trauma in plateau areas.The rate of good recovery in the hematoma enlargement group was significantly lower than that in the hematoma non-enlargement group[32.35％(11/34)vs.71.16％(227/319),x2=21.07,P＜0.001].The length of hospitalization[M(Q1,Q3)]was 17(10,24)days.Log-rank analysis results showed that the difference in survival rates between the two groups was not statistically significant(P＞0.05).Conclusions Patients with craniocerebral trauma in plateau areas who have Sylvian hemorrhage or multiple intracranial hematomas,significant midline shift,low admission GCS,and high admission systolic blood pressure are more likely to have hematoma enlargement after surgery.The short-term prognosis of patients with hematoma enlargement is poor.
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