| Objectives:Through the retrospective analysis of clinical data of the Traumatic Brain Injury patients and the detection of the coagulation and fibrinolytic related indicators, to study the general clinical features, the occurrence risk factors of the delayed postcraniotomy intracranial hematoma and their predictive value, the risk factors of the poor prognosis and their predictive value, as well as their characteristics of coagulation changes.Methods:The clinical data of271TBI patients with whom accompanied by acute intracranial hematoma and were operatively treated by craniotomy were collected. They were divided into three groups:the delayed postcraniotomy intracranial hematoma group (DPIH group)(52cases), the non-delayed postcraniotomy hematoma group (NDPIH group)(219cases) which was further divided into hematoma recurrence group (recurrent at the operative area)(36cases) and the control group (183cases). The data were compared by chi-square test, one-way ANOVA analysis and independent samples t-test or non-parametric tests according to the corresponding style. A logistic regression model was used for the analysis of risk factors for the occurrence of the DPIH and the risk factors of the poor prognosis; finally, receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the related risk factors. Additionally, the blood of another30TBI patients who was operatively treated by craniotomy were collected when immediately admitted to hospital, and the first day,3days and7days postoperative. Blood routine test and coagulation routine test were carried out, the Von Willebrand Factor (VWF), thrombomodulin (TM) and the D-dimer (D-D) were detected by Enzyme-linked immunosorbent assay (ELISA). The patients were divided into DPIH group (8cases) and the control group (22cases) according to the postoperative CT scan, the difference between and within groups were compared.Results:1. The most common hematoma types of the front three in the DPIH group and NDPIH group preoperative were subdural hematoma (61.54%vs.25.11%), epidural hematoma (28.85%vs.32.42%) and intracerebral hematoma(1.92%vs.17.81%), the difference between the two groups were significanct (F=30.488, P=0.000). The incidence of the DPIH of the subdural hematoma and epidural hematoma was36.78%and17.44%. The most common type of the DPIH was epidural hematoma (57.69%), followed by intracerebral hematoma (25%) and subdural hematoma (9.62%). DPIH mostly occurred at2-6hours postoperative (51.92%), and then6-12hours (21.25%) and within2hours postoperative (21.15%).2. The difference of coma and skull fracture rate as well as age, GCS score, diastolic blood pressure, surgical opportunity, fibrinogen (Fbg) and thrombin time (TT) in the DPIH group were significant when compared to the other two groups (P <0.0167and0.05). The difference of the positive Babinski sign rate, herniation rate, basal cistern compression and hematoma volume, blood glucose, prealbumin, activated partial thromboplastin time (APTT) between the DPIH group and the control group was statistically significant.3. Multivariate Logistic regression analysis showed that the TT (P=0.027, OR=1.154), positive Babinski sign (P=0.000, OR=4.107), skull fracture (P=0.000, OR=4.980) and surgical opportunity (P=0.016, OR=0.91) were the risk factors of DPIH, the area under the ROC curve of the above-mentioned variables were0.674,0.641,0.634and0.268.4. Multivariate Logistic regression analysis showed that craniectomy removed (P=0.049, OR=15.302), blood glucose (P=0.016, OR=1.309), delayed postcraniotomy hematoma volume (P=0.018, OR=1.055), postoperative midline shift>1cm (P=0.014, OR=8.054), postoperative basal ganglia compression (P=0.00l, OR=10.455) were the risk factors of the poor prognosis, the corresponding area under the ROC curve were0.634,0.681,0.682,0.701and0.755.5. In the DPIH group, TT prolonged obviously, Fbg and antithrombin III activity decreased significantly, the activity of VWF and D-D concentrations were significantly increased on admittion, the difference was statistically significant when compared with the control group (P<0.05).The difference of prothrombin time (PT), platelet count(PLT), VWF activity, APTT in one day and three days postoperative, as well as TT, VWF and D-D in seven days postoperative between the DPIH group and the control group was statistically significant (P<0.05).Conclusions:1. The patients who had a DPIH was always suffered from severe tranmatic brain injury and mostly conbined with skull fracture, they usually manifested as obvious mass effect incranial and was easilly progressed to herniation.2. The severe TBI patients with whom the preoperative hematomas were subdural hematoma or epidural hematoma were easy to got DPIH. The most common type of the DPIH was epidural hematoma, then the intracerebral hematoma and subdural hematoma, they mostly occurred within12hours especially6hours postoperative.3. The TBI patients of whose TT prolonged, Babinski sign positive, skull fractured, operative earlier were very likely to got DPIH.4. For the DPIH patients with which craniectomy were removed, hyperglycemia, gigantic postcraniotomy hematoma volume, midline shift>lcm and basal ganglia compression postoperative would likely to have a poor prognosis;5. There were obvious coagulapthy in the TBI patients of who got a DPIH. Coagulapthy occurred early even at they admitted to hospital, such change consisted until7days postoperative, and recovered very slowly. |
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