重型颅脑损伤患者术后脑积水形成相关因素分析

Analysis on factors related to postoperative hydrocephalus in patients with severe traumatic brain injury

目的探讨重型颅脑损伤(severe traumatic brain injury,sTBI)患者术后脑积水发生的相关因素。方法回顾性分析经手术治疗,出院后随访6个月的300例sTBI患者的临床资料,根据脑积水诊断标准,分为脑积水组(n=47)和非脑积水组(n=253),比较两组患者颅内血肿部位、手术时间、开放性颅脑损伤、蛛网膜下腔出血(subarachnoid hemorrhage,SAH)、去骨瓣减压、硬脑膜敞开、腰椎穿刺脑脊液置换等因素,采用单因素分析和Lo gistic多元回归法分析上述因素。结果单因素分析发现两组患者血肿部位、开放性损伤、SAH、去骨瓣减压、硬脑膜敞开、腰椎穿刺脑脊液置换差异有统计学意义(P<0.05);Logistic多元回归分析上述因素发现血肿部位(P=0.040,OR=1.431、开放性损伤(P=0.037,OR=1.653)、SAH(P=0.018,OR=1.761)、去骨瓣减压(P=0.035,OR=1.682)、硬脑膜敞开(P=0.014,OR=1.852)、腰椎穿刺脑脊液置换(P=0.023,OR=0.153)为术后脑积水发生的相关因素。结论血肿部位、开放性损伤、SAH、去骨瓣减压、硬脑膜敞开为sTBI术后脑积水发生的危险因素;而腰椎穿刺脑脊液置换为术后脑积水发生的保护因素。

Objective To explore the factors related to postoperative hydrocephalus in patients with severe traumatic brain injury （STB1）. Methods Three hundred sTBI patients treated by surgery were followed-up for 6 months and their clinical records were collected. According to the diagnostic criteria of hydrocephalus, STBI patients were divided into hy- drocephalus group （n=47） and non-hydrocephalus group （n=253）. Univariate and multivariate logistic regression methods were used to analyze the data including the site of intracranial hemorrhage, surgery time, open craniocerebial injury, SAH, decompressive eraniectomy, dural opening and CSF replacement. Results Univariate logistic regression showed that there were significant differences in the site of intracranial hemorrhage, open craniocerebial injury, SAH, decompres- sive craniectomy, dural opening, CSF replacement between two groups （all P〈0.05）. Multivariate logistic regression showed that the factors related to postoperative hydrocephalus were the site of intracranial hemorrhage （P=0.040, OR= 1.431）, open craniocerebial injury （P=0.037, OR=1.653）, SAH （P=0.018, OR=1.761）, decompressive craniectomy （P= 0.035, OR=1.682）, dural opening （P=0.014, OR=1.852） and CSF replacement （P=0.023, OR=0.153）. Conclusion The site of intracranial hemorrhage, open craniocerebial injury, SAH, decompressive craniectomy and dural opening are the risk factors of postoperative hydrocephalus and CSF replacement is the protective factor for the occurrence of postopera- tive hydrocephalus.