颅脑损伤手术中急性脑膨出的形成原因初步探讨

Causes of acute encephalocele during surgery for craniocerebral injury and effective prevention and treatment measures

目的探究颅脑损伤手术中急性脑膨出的形成原因及影响因素,提出有效防治措施。方法选取2014年1月至2016年1月我院神经外科实施开颅手术的颅脑损伤患者130例,根据术中是否发生急性脑膨出分为观察组(发生急性脑膨出)和对照组(未发生急性脑膨出)。收集患者的临床资料,通过单因素卡方检验和多因素Logistic回归分析总结颅脑损伤患者术中发生急性脑膨出的影响因素。结果 40例患者术中发生急性脑膨出,发生率为30.8%。经单因素卡方检验,两组患者性别比、年龄、致伤原因、有无脑脊液漏以及合并多发伤情况差异均无统计学意义(P>0.05);观察组入院后首次格拉斯哥昏迷评分(glasgow coma scale,GCS)<8分、受伤至手术时间<3 h、合并手术远隔部位颅骨骨折、合并迟发性外伤性颅内血肿(delayed traumatic intracranial hematoma,DTIH)以及合并外伤性弥漫性脑肿胀(post-traumatic acute diffuse brain swelling,PADBS)的比例均高于对照组,差异均有统计学意义(P<0.05)。经多因素Logistic回归分析,入院后首次GCS评分低、受伤至手术时间短以及合并手术远隔部位颅骨骨折、DTIH和PADBS均为颅脑损伤患者术中发生急性脑膨出的危险因素。结论颅脑损伤患者手术过程中发生急性脑膨出的几率较高,且与入院后首次GCS评分、受伤至手术时间以及合并手术远隔部位颅骨骨折、DTIH和PADBS情况相关,术前应对患者发生急性脑膨出的风险进行综合评估。

Objective To investigate the causes of acute encephalocele during the surgery for craniocerebral injury and effective prevention and treatment measures. Methods A total of 130 patients with craniocerebral injury who underwent craniotomy in Department of Neurosurgery in our hospital from January 2014 to January 2016 were enrolled,and according to the presence or absence of acute encephalocele during surgery,the patients were divided into observation group（ with acute encephalocele） and control group（ without acute encephalocele）. Their clinical data were collected,and the univariate chi-square test and the multivariate logistic regression analysis were used to identify the influencing factors for acute encephalocele during surgery in patients with craniocerebral injury. Results Of all patients,40（30. 8%） experienced acute encephalocele. The results of the univariate chi-square test showed that there were no significant differences in sex ratio,age,cause of injury,presence or absence of cerebrospinal fluid leakage,and multiple injuries between the two groups（ P〈0. 05）. Compared with the control group,the observation group had significantly higher proportions of patients with initial Glasgow Coma Scale（ GCS） score after admission 8,time from injury to surgery 3 hours,skull fracture away from the surgery site,delayed traumatic intracranial hematoma（ DTIH）,and post-traumatic acute diffuse brain swelling（ PADBS）（ P〈0. 05）. The multivariate logistic regression analysis showed that a low initial GCS score after admission,a short time from injury to surgery,skull fracture away from the surgery site,DTIH,and PADBS were risk factors for acute encephalocele during the surgery for craniocerebral injury. Conclusions Patients with craniocerebral injury have a high possibility of acute encephalocele during the surgery for craniocerebral injury,which is associated with the initial GCS score after admission,time from injury to surgery,skull fracture away from the surgery site,DTIH,and PADBS. A comprehensive evaluation of the risk of acute encephalocele should be performed before surgery.