颅脑损伤术后脑积水危险因素的探讨

Risk factors related to hydrocephals after decompressive craniotomy in patients with head injury

目的探讨颅脑损伤术后发生脑积水的危险因素及预防策略。方法回顾2008年10月～2010年3月间收治的312例开颅手术的颅脑损伤患者临床资料,按有、无脑积水分组,对照分析性别、年龄、GCS评分、脑疝、脑挫裂伤及梗死体积、蛛网膜下腔出血、血肿位置、伤后手术时间、术后颅内压等对脑积水发生的影响。结果 312例中发生脑积水31例,未发生脑积水281例。通过χ2检验、Fish确切检验单因素分析发现并发脑积水的影响因素为:患者年龄、入院GCS评分、脑疝、脑组织挫裂伤及梗死体积、血肿位置、弥漫性蛛网膜下腔出血、术后颅内压,而与性别、伤后至第一次手术时间无关。Logistic回归分析上述影响因素发现,脑疝、脑组织挫裂伤及梗死体积、蛛网膜下腔出血与术后脑积水密切相关,而GCS评分、血肿位置、颅内压与术后脑积水相关无统计学意义。结论脑疝、脑组织挫裂伤及梗死体积、弥漫性蛛网膜下腔出血是颅脑损伤术后发生脑积水的主要危险因素,争取脑疝形成前手术、改善手术技巧、引流血性脑脊液可能减少脑积水发生率。

Objective To detect the risk factors related to hydrocephalus after decompressive craniotomy in patients with head injury and its prevention strategy.Methods Clinical data on 312 cases after decompressive craniotomy were collected retrospectively for this study.The patients were divided into two groups： hydrocephalus group as study group and non-hydrocephalus group as control group.In this two groups,gender,age,Glasgow coma scale（GCS） at admission,cerebral hernia,contusion and laceration of brain,infarction area,subarachnoid hemorrhage,location of hemotoma,operative time after injury,postoperative intracranial pressure were analyzed to investigate their effects on the development of hydrocephalus.Results Of the 312 patients,hydrocephalus was observed in 31 patients.Chi-square test,Fish exact inspection and logistic regression analysis were use to indicate the risk factors： age,Glasgow coma scale（GCS） at admission,cerebral hernia,contusion and laceration of brain,infarction area,subarachnoid hemorrhage,and postoperative intracranial pressure.And Logistic regression analysis showed the risk factors as follows： cerebral hernia,contusion and laceration of brain,infarction area,subarachnoid hemorrhage,and postoperative intracranial pressure.Conclusion Cerebral hernia,contusion and laceration of brain,infarction area,subarachnoid hemorrhage are the primary risk factors of the hydrocephalus after decompressive craniotomy.Actively performing operation before cerebral herniation,improving the surgical technique and draining bloody cerebrospinal fluid may reduce the incidence of hydrocephalus.