重型颅脑损伤术后发生脑积水的危险因素分析

Analysis of risk factors for postoperative hydrocephalus in patients with severe traumatic brain injury

目的探讨重型颅脑损伤患者术后脑积水发生的危险因素。方法回顾性分析手术后276例重型颅脑损伤手术患者的临床资料。随访6个月后根据脑积水诊断标准,分为脑积水组(47例)和非脑积水组(229例),采用单因素分析和逐步Logistic回归分析,比较两组患者颅内脑挫裂伤、脑室出血、硬膜下血肿、硬膜外血肿、颅骨损伤、颅骨线型骨折、脑脊液蛋白水平及压力等因素。结果随访结果显示,重型颅脑损伤患者术后脑积水发生率为17.03%(47/276);单因素分析结果显示脑积水组和非脑积水组在年龄、脑室出血、硬膜下血肿、昏迷(有无、持续时间)、格拉斯哥昏迷评分(Glasgow Coma Scale,GCS)、去骨瓣减压术、创伤性蛛网膜下腔出血(traumatic subarachnoid hemorrhage,tSAH)、加尔维斯顿定位和失忆测试(Galveston Orientation and Amnesia Test,PTA)、功能独立性测评(Function Independent Measure,FIM)的差异均有统计学意义(P<0.05);Logistic回归结果显示高龄、硬膜下血肿、昏迷时间长、GCS低分值,去骨瓣减压术与重型颅脑创伤后的脑积水的发生显著正相关。结论高龄、有硬膜下血肿、GCS评分低、接受去骨瓣减压术是重型颅脑创伤后脑积水的危险因素。

Objective To investigate the risk factors for postoperative hydrocephalus in patients with severe traumatic brain injury.Methods A retrospective analysis was performed on the clinical data of 276 patients with severe traumatic brain injury treated by sur-gery. Follow-up was performed for six months. These patients were divided into hydrocephalus group （ n = 47） and non-hydrocephalusgroup （ n = 229） according to the diagnostic criteria for hydrocephalus. The two groups were compared in terms of cerebral contusionand laceration, intraventricular hemorrhage, subdural hematoma, epidural hematoma, skull injury, linear skull fracture, cerebrospinalfluid protein level, cerebrospinal fluid pressure, and so on, and these factors were subjected to univariate analysis and stepwise logisticregression analysis. Results The follow-up results showed that the incidence of postoperative hydrocephalus in patients with severetraumatic brain injury treated by surgery was 17.03 % （47/276）. The univariate analysis showed that there were significant differencesin age, intraventricular hemorrhage, subdural hematoma, coma （presence or absence and duration） , Glasgow Coma Scale （GCS）score, decompressive craniectomy, traumatic subarachnoid hemorrhage, Galveston Orientation and Amnesia Test, and Function Inde-pendent Measure between the two groups （P 〈 0.05 ）. The logistic regression analysis showed that the factors related to postoperativehydrocephalus in patients with severe traumatic brain injury were age, subdural hematoma, coma （presence or absence and duration） , GCS score, and decompressive craniotomy. Conclusions Older age, subdural hematoma, low GCS score, and decompressive craniotomy are risk factors for postoperative hydrocephalus in patients with severe traumatic brain injury.