目的 探讨早期CT扫描在开颅患 者术后颅内出血中的诊断价值。方法 选 取2014年4月至2015年6月于我院实施开 颅手术的患者160例为研究对象，根据术 后是否发生颅内出血将其分为A组(n=40) 和B组(n=120)，对比两组临床资料，分 析开颅手术患者术后发生颅内出血的危 险因素，统计术后颅内出血发生率及术 后发现颅内出血的时间，同时分析术后 早期CT扫描中颅内出血的影像特征。结 果 A组疾病类型分布、术中行脑室外引 流、术中出血量与B组比较有显著差异(P 均<0.05)；多因素Logistic回归分析结果 显示术中行脑室外引流、术中出血量、高 血压病史为开颅手术患者术后发生颅内出 血的独立危险因素；本组中术后7例经CT 检查发现颅内出血，术后颅内出血CT检 出率4.37%(7/160)，其中5例发生于基底 节区(71.43%)，发生于丘脑、小脑各1例 (14.29%、14.29%)；术后首次头颅CT检查 发现颅内出血概率3.75%、无颅内出血相 关临床表现；行常规术后首次头颅CT检查 发现颅内出血概率0.62％低于术后颅内 出血发生率4.37%(P1>0.05；P2<0.05)； 开颅术后6h内、6h-24h、24h后首次头颅 CT检查发生颅内出血概率分别为2.50%、 1.25%、0，比较无显著差异(P>0.05)。结 论 开颅患者术后早期(术后6h内)行CT扫 描对诊断颅内出血中具有较高价值，尤其 对存在高危因素患者，应尽快行CT扫描排 除颅内出血。

Objective To investigate the value of early CT scanning in the diagnosis of intracranial hemorrhage after craniotomy. Methods The clinical data of 160 patients who underwent craniotomyin our hospital between April 2014 and June 2015 were analyzed. According to the incidence of postoperative intracranial hemorrhage, the patients were divided into group A (n=40) and group B (n=120). The risk factors of intracranial hemorrhage after craniotomy were analyzed. The incidence rate of postoperative intracranial hemorrhage and the time of intracranial hemorrhageafter operation were statistically analyzed. The imaging features of intracranial hemorrhagewere analyzed. Results There were significant differences in distribution of disease types, external ventricular drainage andintraoperative blood loss between group A and group B (all P<0.05). Multivariate Logistic regression analysis showed that the independent risk factors of intracranial hemorrhage after craniotomy included intraoperative blood lossand history of hypertension, after craniotomy, there were 7 cases with intracranial hemorrhage, CT detection rate of postoperative intracranial hemorrhage was 4.37%, including 5 cases (71.43%) in basal ganglia, 1 case (14.29%) in thalamus and in case (14.29%) in cerebellum;after craniotomy, the initial head CT examination showed that the probabilityof intracranial hemorrhage was 3.75%, without intracranial hemorrhage related manifestations. After conventional surgery, the initial head CT examination showed that the probabilityof intracranial hemorrhage was0.62%,lower than the incidence of intracranial hemorrhage (4.37%) (P1>0.05, P2<0.05), in 6h, 5h-24h and 24h after craniotomy, the initial head CT examination showed that the probabilitiesof intracranial hemorrhage were 2.50%, 1.25% and 0, respectively(P>0.05). Conclusion Early (in postoperative 6h) CT scanning after craniotomy is of high value in the diagnosis of intracranial hemorrhage, especially for patients with high risk factors, CT scan should be performed as soon as possible to exclude intracranial hemorrhage.