重型创伤性脑损伤患者发生脑积水的危险因素分析

Analysis of the Risk Factors for the Occurrence of Hydrocephalus in Patients with Severe Traumatic Brain Injury

目的分析诱发重型创伤性脑损伤(traumatic brain injury,TBI)患者发生脑积水的危险因素,为重型TBI患者脑积水的预防提供参考依据。方法选取我院2013年1月-2016年1月收治的162例重型TBI患者为研究对象,进行回顾性分析。162例患者均接受了为期6个月的随访,将随访期间发生脑积水患者纳入发生组,将未发生脑积水患者纳入未发生组,计算患者脑积水发生率,并比较两组患者一般临床特征,运用多因素Logistic回归分析重型TBI患者发生脑积水的危险因素。结果 162例患者中,随访期间共有28例发生脑积水,发生率为17.28%。患者脑积水发生时间为伤后1~9周,中位发生时间为3周。发生组与未发生组患者GCS评分、PTA评分、FIM评分差异有统计学意义(P均<0.05);年龄、昏迷时间及蛛网膜下腔出血、大脑凸面硬脑膜下积液、颅骨缺损、中线偏移、开颅手术情况两组间差异有统计学意义(P均<0.05)。多因素回归分析示,GCS评分<11分、年龄≥60岁、昏迷时间≥7 d、中线偏移≥10 mm、开颅手术、单侧颅骨缺损骨瓣下界距颧弓水平距离≤10 mm是导致重型TBI患者发生脑积水的独立危险因素(P<0.05)。结论重症创伤性脑创伤患者中GCS评分<11分、年龄≥60岁、昏迷时间≥7d、中线偏移≥10mm、开颅手术、单侧颅骨缺损骨瓣下界距颧弓水平距离≤10mm是导致患者发生脑积水的独立危险因素。

Objective To analyze the risk degree of hydrocephalus in patients with severe traumatic brain injury （TBI） and to provide references for the prevention of hydrocephalus in patients with severe TBI. Methods 162 patients with severe TBI ＇from January 2013 to January 2016 in our hospital were selected and analyzed retrospectively. All the patients were followed up for 6 months. Patients with hydrocephalus during follow-up were taken as the occurrence group while the patients without hydrocephalus as the nonoccurrence group. The incidence rate of hydrocephalus, general pathological conditions, diagnosis and treatment, etc. between the two groups were compared and the risk factors of hydrocephalus in patients with severe TBI were analyzed by using the Logistic regression analysis. Results 28 cases of 162 patients were found hydrocephalus during the follow-up period and the incidence rate was 17.28%. Patients with hydrocephalus occurred at 1-9th week after the injury and the median time of occurrence was 3 weeks. Multivariate regression analysis showed that GCS score, age（ ≥ 60yeats）, coma time（ ≥ 7d）, midline shift （ ≥ 10mm）, craniotomy, unilateral skull bone flap from the lower level of the zygomatic arch distance （≤10mm）were independent risk factors for hydrocephalus in patients with severe TBI （P〈0.05）. Conclusion The risk of hydrocephalus in patients with severe TBI is high, which is closely related to the pathological conditions, the diagnosis and treatment of the patients. Controlling the risk factors will be helpful for reducing the incidence of hydrocephalus after injury and promoting the improvement of the prognosis.