The Clinical Research Of Delayed Traumatic Intracranial Hemorrhage Following Large Decompressive Craniectomy In Patients With Severe Traumatic Brain Injury

Objective: To explore the frequency, risk factors, clinical features and influence in prognosis of delayed traumatic intracranial hematoma(DTICH) following unilateral large decompressive craniectomy(LDC) in the severe traumatic brain injury(s TBI) patients, and to improve the successful rate of the rescue.Methods: The clinical data of 130 s TBI patients underwent unilateral LDC was retrospectively analyzed. The patients were divided into DTICH group and non-DTICH group according to whether the DTICH occurred after operation. The risk factors of DTICH and its influence were contrastively analyzed. Furthermore, analyze the patterns, locations, discovery times and therapeutic methods of DTICH in DTICH group.Results: Among the 130 patients, a total of 42 patients(32.3%) occurred DTICH after operation. The analysis results of the clinical data of patients in two groups showed that preoperative GCS score, time from trauma to operation, skull fracture, midline shift > 1 cm, basal cistern disappear, activated partial prothrombin time(APTT), fibrinogen(FIB) and thrombin time(TT) were significantly correlated with the appearance of DTICH(P < 0.05). Multivariable Logistic regression analysis showed that the time from trauma to operation(OR=6.799;95% CI 2.290-20.184, P=0.001), skull fracture(OR=4.564;95% CI 1.394-14.942,P=0.012), basal cistern disappear(OR=13.563;95% CI 2.816-65.326, P=0.001) and FIB(OR=2.879;95% CI 1.061-7.808,P=0.038) were independent risk factors of DTICH(P < 0.05). The analysis results of GOS scores 3 months after operation of the patients in two groups showed that the prognosis of the patients in DTICH group was significantly worse than that in non-DTICH group(P < 0.01). Among 42 cases of DTICH group, there were delayed intracerebral hematoma(DICH) in 22, delayed epidural hematoma(DEDH) in 13, delayed subdural hematoma(DSDH) in 7. Twenty-five cases occurred on the contralateral side of operation, 15 occurred on the same side, 2 occurred on the both side. The mean discovery time is 9.1 hours after the operation. Among them, 3 cases were detected in the operation, 38 were detected in the first 24 hours after the operation, 1 was detected after 24 hours from the operation. Ten cases were detected by the deteriorative clinical features, 32 were detected by the repeated brain CT. Twelve cases were treated by the second operation, 3 were refused, 27 were treated by conservative treatment. Among the 12 cases who treated by the second operation, 9 on the account of DEDH, 2 on the account of DSDH, 1 on the account of DICH.Conclusion: The frequency of DTICH following unilateral LDC in the s TBI patients was comparable with the results previous studies. Most DTICH occurred in the first 24 hours after operation and located in the contralateral side of operation, DICH is the most common pattern. It can only discover few DTICH by the deteriorative clinical features. DEDH is the primary reason for the second operation. DTICH can affect the prognosis of patients, therefore, we should evaluate the risk factors of DTICH occurred in detail before the s TBI patients treated by unilateral LDC. Especially in those patients who accompanied with shorter time from trauma to operation, skull fracture, basal cistern disappear and FIB decrease, the DTICH is more likely to occur.