Effect of intracranial pressure on prognosis after drilling and drainage in patients with traumatic acute subdural haematoma.

doi:10.19854/j.cnki.1008-2425.2025.01.0008

Abstract

Abstract: Objective To investigate the effect of intracranial pressure(ICP) levels after drilling and drainage on the prognosis of patients with traumatic acute subdural haematoma(ASDH). Methods A total of 113 patients with acute subdural hematoma(ASDH) who underwent surgical intervention at our institution between October 2020 and September 2023 were retrospectively analyzed.Patients were stratified into two groups based on their postoperative prognoses:a favorable prognosis group(n=67) and a poor prognosis group(n=46).Patient demographics were collected from both groups,and intracranial pressure(ICP) parameters and cerebral hemodynamic levels were compared at 1 day,3 days,and 7 days postoperatively.Generalized Estimating Equations(GEE) were employed to compare ICP parameters and cerebral hemodynamic parameters across different time points among ASDH patients with varying prognoses.Receiver Operating Characteristic(ROC) curves were used to analyze the predictive value of ICP parameters at 1 day postoperatively for the prognosis of ASDH patients;Restricted cubic spline(RCS) was used to analyse the dose-response relationship between intracranial pressure parameters and poor prognosis in patients with ASDH. Results The results of GEE equations showed that the differences in intracranial pressure parameters,cerebral haemodynamic indices between groups,time points and interactions were statistically significant in all groups(P＜0.05).RCS analysis showed a linear dose-response relationship between ICP,PRx,MWA,Dicp20,AMP,and RAP levels and prognosis of ASDH patients(P＜0.05).The results of the ROC curves showed that ICP,PRx,MWA,Dicp20,AMP,RAP and the combination of all six had some diagnostic efficacy for prognostic outcomes in ASHD patients(P＜0.05). Conclusion Early monitoring of ICP levels in patients with ASDH after drilling and drainage can predict the prognosis of patients with ADSH and provide timely clinical intervention,which is helpful to improve the long-term prognosis of patients.

Key words: Acute subdural hematoma, Drilling and drainage, Intracranial pressure, Prognosis, Influencing factors

摘要： 目的探究钻孔引流术后颅内压(ICP)水平对创伤性急性硬膜下血肿(ASDH)患者预后的影响。方法分析2020年10月-2023年9月于我院就诊并进行钻孔引流术的ASDH患者113例,根据患者不同预后情况将患者分为预后良好组(n=67)和预后不良组(n=46)。收集两组患者一般资料,比较两组患者术后1 d、术后3 d、术后7 d颅内压参数、脑部血流动力学水平;采用广义估计方程(GEE)比较不同预后ASDH患者术后不同时间点颅内压参数及脑血流动力学参数;使用受试者工作曲线(ROC)分析ASDH患者术后1d颅内压参数对预后的预测价值;采用限制性立方样条(RCS)分析颅内压参数与ASDH患者不良预后的剂量-反应关系。结果 GEE方程结果显示:各组患者颅内压参数、脑部血流动力学指标组间、时间点及交互差异均具有统计学意义(P＜0.05)。RCS分析结果显示:ICP、PRx、MWA、Dicp20、AMP、RAP水平均与ASDH患者预后之间存在线性剂量-反应关系(P＜0.05)。ROC曲线结果显示:ICP、PRx、MWA、Dicp20、AMP、RAP及六者联合均对ASHD患者预后结局具有一定的诊断效能(P＜0.05)。结论钻孔引流术后早期对ASDH患者ICP水平进行监测,可对ADSH患者预后进行预测,并给予及时临床干预,有利于提升患者远期预后。

关键词: 创伤性急性硬膜下血肿, 钻孔引流术, 颅内压, 预后, 影响因素

CLC Number:

R651.1

Guo Jing, Jiang Lingli, Yin Na, Zhang Hongru, Shao Yu, Ma Yuan. Effect of intracranial pressure on prognosis after drilling and drainage in patients with traumatic acute subdural haematoma.[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2025, 38(1): 41-48.

郭静, 蒋玲俐, 殷娜, 张红汝, 邵宇, 马原. 创伤性急性硬膜下血肿患者钻孔引流术后颅内压对预后的影响[J]. 立体定向和功能性神经外科杂志, 2025, 38(1): 41-48.

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