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在患有慢性腹腔内血瘤的患者中,手术的时间和术后功能结果
Asfand Baig Mirza1,2, James Knight2, Pak Yin Lam3
1Department of Neurosurgery, Queen's Hospital, Romford, UK.
Journal of neurology, neurosurgery, and psychiatry
|January 28, 2026
概括
慢性腹腔内血瘤 (cSDH) 的手术延迟显著恶化了患者的结果. 诸如老年和抗血小板使用等因素有助于这些延迟,影响恢复.
科学领域:
- 神经外科 神经外科
- 神经学 神经学
- 临床结果研究研究
背景情况:
- 慢性腹腔内血瘤 (cSDH) 是一种常见的神经疾病,需要在有症状的患者手术干预.
- 在cSDH管理中的手术延迟可能源于各种后勤,临床和药物相关因素.
- 研究手术时间对cSDH手术后功能结果的影响对于优化患者护理至关重要.
研究的目的:
- 为了检查在症状慢性下皮层血瘤的患者手术前的时间和术后功能结果之间的关联.
- 确定手术延迟的预测因素及其对患者结果的影响.
主要方法:
- 一项回顾性多中心队列研究,涉及5个英国神经外科单位 (2012-2023) 的1015名cSDH患者.
- 使用修改的兰金尺度 (mRS) 评估的术后功能结果,分为"有利" (0-3) 和"不利" (4-6).
- 用多变量逻辑回归和边际效应分析来评估手术时间和结果之间的关系,用多变量线性回归来评估影响延迟的因素.
主要成果:
- 大多数患者 (82.6%) 取得了良好的结果,而17.4%的患者有不良结果.
- 在不良结局的患者中,手术延迟明显较长 (平均4.4天与2.9天相比,p<0.001).
- 每增加一天的手术延迟独立地增加了较差结果的风险 (OR=1.05每天,p=0.002),风险在30日升至28%. 导致延迟的因素包括年龄较大,抗血小板使用,高格拉斯哥昏迷表得分和低脆弱性得分.
结论:
- 手术延迟是慢性皮下血瘤患者功能结果恶化的重要独立预测因素.
- 老年,抗血小板治疗,较温和的神经表现 (高GCS) 和低脆弱性得分被确定为导致手术介入延迟的关键因素.
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