Coagulopathy and outcome in patients with chronic subdural haematoma
Coagulopathy and outcome in patients with chronic subdural haematoma
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DOI：
10.1034/j.1600-0404.2003.01340.x
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发表时间：
2003-02-01
影响因子：
3.5
通讯作者：
Vitzthum, HE
中科院分区：
文献类型：
--
作者：
König, SA;Schick, U;Vitzthum, HE
目的：凝血障碍和慢性硬膜下血肿(CSH)的重合需要纠正凝血以便于手术。我们调查了CSH患者凝血障碍与预后的相关性。材料和方法：我们分析了114例患者的既往病史、手术治疗和凝血参数。结果：42%的患者存在凝血功能障碍。14%的患者需要进行凝血酶原复合体的术前治疗。复发组与未复发组的术前血小板水平有显著差异(P<；0.05)。总体而言，17.5%的患者需要再次手术。81例患者格拉斯哥昏迷评分(GCS)=13分。术后GCS评分=13分92例。GCS评分改善46例，维持GCS评分水平61例。结果在酗酒组(P<；0.001)和复发组(P<；005)明显更差。在凝血因子替代的患者中，术后仅替代凝血因子的患者预后较差(P<；0.05)。结论：在CSH中，凝血参数和细微的凝血纠正是特别有意义的，因为复发的CSH患者和术后需要替换的患者的预后较差。
Objective - The coincidence of coagulatopathy and chronic subdural haematoma (CSH) requires correction of coagulation to facilitate surgery. We investigated the correlation between coagulopathy and outcome in CSH patients. Material and methods - We analysed past medical history, surgical treatment and coagulation parameters of 114 patients. Results - Coagulation disorders were found in 42%. Preoperative treatment with prothrombin complex concentrate was necessary in 14%. A significant difference (P < 0.05) of the preoperative level of platelets was found between recurrent CSH and non-recurrent group. Totally, we had to perform re-operations in 17.5%. Eighty-one patients presented with Glasgow coma scale (GCS) >= 13. After surgery GCS was >= 13 in n = 92. There was an improvement of GCS in 46 cases, 61 patients maintained GCS score levels. Outcome was significantly worse in the alcoholic group (P < 0.001), and in the recurrent group (P < 0.05). In patients with substitution of coagulation factors, outcome was worse in the group with post-operative substitution only (P < 0.05). Conclusion - In CSH, the coagulation parameters and a subtle correction of coagulation are of special interest, regarding the worse outcome in patients with recurrent CSH and in those requiring post-operative substitution.