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Objective:To observe the natural course of patients with simple traumatic intraparenchymal contusions and hematomas (TIPHs), and analyze the risk factors for TIPHs progression.Methods:Using a prospective observational study, 69 patients with TIPHs in Affiliated Xiaolan Hospital, Southern Medical University from July 2018 to January 2020 were selected. The gender, age, cause of injury, compound injury status, combined injury and Glasgow coma score (GCS) were recorded. The plasma levels of prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), fibrinogen (Fbg), international normalized ratio (INR), D-dimer, platelet, hemoglobin at admission were detected. The occurrence of hypoxemia and high intracranial pressure were observed. The time of the first CT examination, volume of the first CT hematoma, time of the control CT examination, volume of the control CT hematoma, and lesion morphology, multifocality, subarachnoid hemorrhage (SAH), edema zone and cortical distance showed in the first CT examination were recorded. The risk factors of progression in patients with TIPHs were analyzed.Results:Among 69 patients with TIPHs, TIPHs progression was in 28 cases (progression group), and the progression rate was 40.58%; TIPHs progression was not in 41 cases (non-progression group). There were no statistical differences in gender composition, age, PT, APTT, INR, hemoglobin, cause of injury, compound injury, incidence of hypoxemia, incidence of high intracranial pressure, incidence of SAH, incidence of edema zone, incidence of irregular lesions, time of the first CT examination, time of the control CT examination and volume of the first CT hematoma between 2 groups ( P>0.05). The GCS, cortical distance and Fbg in progression group were significantly lower than those in non-progression group, the TT, platelet, multifocality rate and volume of the control CT hematoma were significantly higher than those in non-progression group, and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistic regression analysis result showed that cortical distance <1 cm, Fbg<2 g/L and multifocality were independent risk factors affecting the progression in patients with TIPHs ( OR = 6.723, 5.515 and 4.827; P<0.05). The model had a sensitivity of 71.43% (20/28), a specificity of 92.68% (38/41), and an accuracy of 84.06% (58/69) in judging the progression of TIPHs. Conclusions:Based on the risk factors for the progression of TIPHs, predicting these patients in advance can provide necessary intervention measures for high-risk patients, which will help to reduce the rate of progression and improve the prognosis of patients.
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Objective:To observe the natural course of cerebral contusion and laceration combined with hematoma formation and analyze the risk factors for its progression.Methods:Patients with cerebral contusion and laceration combined with hematoma formation admitted to our hospital from September 2017 to March 2020 were prospectively selected; and they were divided into progressive and non-progressive groups according to progression of cerebral contusion and laceration combined with hematoma formation. The clinical data of the two groups of patients were compared, and multivariate Logistic regression was used to analyze the independent influencing factors for progressive cerebral contusion and laceration combined with hematoma formation.Results:A total of 197 patients with cerebral contusion and laceration combined with hematoma formation were included in this study, of which, 61 were treated with craniotomy and 136 were treated conservatively; 85 patients had progressive cerebral contusion and laceration combined with hematoma formation and 112 patients had non-progressive cerebral contusion and laceration combined with hematoma formation. As compared with those in the non-progressive group, the baseline Glasgow Coma Scale (GCS) scores of the progressive group were lower, hematoma volume by second CT scan was larger, distance from the center of cerebral contusion and laceration or hematoma to the nearest cortex was shorter, platelet count and thrombin time increased, fibrinogen (FIB) content decreased, and proportion of patients with multiple lesions in the first CT scan was higher in the progressive group, with significant differences ( P<0.05). Multivariate Logistic regression analysis showed that the distance from the center of cerebral contusion and laceration or hematoma to the nearest cortex<1 cm, plasma FIB<2 g/L, multiple lesions of cerebral contusion and laceration or hematoma on first CT scan were risk factors for progression in patients with cerebral contusion and laceration combined with hematoma formation ( OR=6.654, 95%CI: 1.391-35.089, P=0.025; OR=5.617, 95%CI: 1.136-28.022, P=0.034; OR=4.629, 95%CI: 1.178-20.071, P=0.031). Conclusion:The patients with short distance from the center of cerebral contusion and laceration or hematoma to the nearest cortex, low plasma FIB, and multiple lesions of cerebral contusion and laceration or hematoma on first CT scan are prone to have progressive cerebral contusion and hematoma formation.
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Objective To investigate the clinical characteristics and therapeutic strategy of acute subdural hematoma. Methods A restrospective study was carried out with a total of 94 consecutive ASDH patients who were confirmed through computed tomographic scan and obtained the clinical characteristics by experienced neurosurgeons.15 cases werepure acute subdural hematoma and the other 79 cases were acute compound subdural hematoma according to CT scan. Results In accordance with the GOS,36 cases had good recovery,19 cases had moderate disability,17 cases had severe disability and 22 cases dead. Conclusion The most important treatment for pure acute subdural hematom was to diagnose the source of bleeding, and acute compound subdural hematoma had poor prognosis than pure acute subdural hematoma since the traumatic severity. Early decraniuim by large bone flap to treat acute compound subdural hematoma could improve survival rate,reduce the fatality rate and decrease postoperative complications.