重型自发性脑出血患者去骨瓣减压术中骨瓣还纳决策的影响因素

doi:10.3969/j.issn.1671-7171.2026.03.027

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摘要 【目的】探讨重型自发性脑出血患者去骨瓣减压术中骨瓣还纳决策的影响因素。【方法】回顾性分析2022年2月至2025年2月本院收治的64例重型自发性脑出血患者的临床资料,根据术中是否还纳骨瓣将患者分为还纳组(n=30)和未还纳组(n=34)。比较两组患者的基线资料及临床特征,通过单因素和多因素Logistic回归筛选与骨瓣还纳决策相关的影响因素,比较两组患者短期预后良好率。根据术后3个月格拉斯哥预后量表(GOS)评分,将还纳组患者进一步分为良好预后组(n=18)与不良预后组(n=12),分析影响骨瓣还纳患者预后的相关因素。【结果】还纳组患者年龄及术中急性脑膨出、血肿破入脑室及中线移位的发生率均低于未还纳组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄、血肿破入脑室、术中急性脑膨出及中线移位是重型自发性脑出血患者骨瓣还纳的影响因素(均P<0.05)。随访3个月,还纳组预后良好患者18例(60.00%),未还纳组预后良好患者12例(35.29%),还纳组预后良好率高于未还纳组(χ²=3.906,P=0.048)。在骨瓣还纳患者中,不良预后组的年龄及中线移位、术后脑积水、术后2周重度脑水肿的发生率均高于良好预后组,术后1周GCS评分低于不良预后组,差异有统计学意义(P<0.05)。【结论】年龄、血肿破入脑室、术中急性脑膨出及中线移位是影响重型自发性脑出血患者术中骨瓣还纳决策的关键影响因素,对于具备还纳条件的患者,接受一期还纳者短期预后良好率更高,但高龄、术前中线移位以及术后脑积水、重度脑水肿、早期神经功能状态差仍是骨瓣还纳患者短期预后不良的重要指标。

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	张成
	厉进辉

关键词 ：脑出血, 减压颅骨切除术

Abstract：【Objective】 To explore the clinical factors influencing the decision of bone flap replantation during decompressive craniectomy in patients with severe spontaneous intracerebral hemorrhage. 【Methods】 The clinical data of 64 patients with severe spontaneous intracerebral hemorrhage admitted to our hospital from February 2022 to February 2025 were retrospectively analyzed. According to whether the bone flap was replanted during the operation, the patients were divided into the replantation group (n=30) and the non-replantation group (n=34). The baseline data and clinical characteristics of the two groups were compared. Univariate and multivariate Logistic regression were used to screen the clinical factors related to the bone flap replantation decision, and the short-term good prognosis rate of the two groups was compared. According to the Glasgow Outcome Scale (GOS) score 3 months after operation, the patients in the replantation group were further divided into the good prognosis group (n=18) and the poor prognosis group (n=12), and the related factors affecting the prognosis of the patients with bone flap replantation were analyzed. 【Results】 The age of patients in the replantation group and the incidence of acute intraoperative cerebral herniation, hematoma rupture into the ventricle and midline shift were lower than those in the non-replantation group, with statistically significant differences (P<0.05). Multivariate Logistic regression analysis showed that age, hematoma rupture into the ventricle, acute intraoperative cerebral herniation and midline shift were the influencing factors for bone flap replantation in patients with severe spontaneous intracerebral hemorrhage (all P<0.05). After 3 months of follow-up, 18 patients (60.00%) in the replantation group had a good prognosis, and 12 patients (35.29%) in the non-replantation group had a good prognosis. The good prognosis rate of the replantation group was higher than that of the non-replantation group (χ²=3.906, P=0.048). Among the patients with bone flap replantation, the age, incidence of midline shift, postoperative hydrocephalus and severe cerebral edema 2 weeks after operation in the poor prognosis group were higher than those in the good prognosis group, and the GCS score 1 week after operation was lower than that in the poor prognosis group, with statistically significant differences (P<0.05). 【Conclusion】 Age, hematoma rupture into the ventricle, acute intraoperative cerebral herniation and midline shift are the key clinical factors affecting the decision of bone flap replantation during decompressive craniectomy in patients with severe spontaneous intracerebral hemorrhage. For patients with replantation conditions, those who receive primary replantation have a significantly higher short-term good prognosis rate. However, among patients with bone flap replantation, advanced age, preoperative midline shift, postoperative hydrocephalus, severe cerebral edema and poor early neurological status are still important indicators of poor short-term prognosis.

Key words： Cerebral Hemorrhage Decompressive Craniectomy

收稿日期: 2025-12-12

中图分类号:

R743.34

引用本文:

张成, 厉进辉. 重型自发性脑出血患者去骨瓣减压术中骨瓣还纳决策的影响因素[J]. 医学临床研究, 2026, 43(3): 449-452.
ZHANG Cheng, LI Jinhui. Influencing Factors of Bone Flap Replantation Decision in Decompressive Craniectomy for Patients with Severe Spontaneous Intracerebral Hemorrhage. JOURNAL OF CLINICAL RESEARCH, 2026, 43(3): 449-452.

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http://journal07.magtech.org.cn/yxlcyj/CN/10.3969/j.issn.1671-7171.2026.03.027 或 http://journal07.magtech.org.cn/yxlcyj/CN/Y2026/V43/I3/449

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