重型颅脑损伤后并发脑积水的危险因素分析

Risk factors related to hydrocephalus after large decompressive craniectomy in patients with severe craniocerebral injury

目的探讨重型颅脑损伤去大骨瓣减压术后并发脑积水的相关危险因素。方法回顾性分析2012年3月至2015年7月去大骨瓣减压术治疗的104例重型颅脑损伤的临床资料。采用多因素Logistic回归分析检验脑积水的危险因素。结果出院后随访9个月,104例中,发生脑积水24例(23.08%),未发生脑积水80例(76.92%)。多因素Logistic回归分析显示,年龄≥50岁、脑室出血、昏迷、硬膜下血肿、入院时GCS评分3~5分、骨窗面积≥120 cm2、双侧去骨瓣减压术是重型颅脑损伤去骨瓣减压术后并发脑积水的独立危险因素(P<0.05),而早期颅骨缺损修补术却可以减少脑积水的发生率(P<0.05)。结论重型颅脑损伤去大骨瓣减压术后并发脑积水的危险因素众多,包括高龄、脑室出血、昏迷、硬膜下血肿、骨窗面积、双侧去骨瓣减压术、未行早期颅骨缺损修补术等,临床应给予相应措施以减少脑积水的发生率。

Objective To explore the risk factors related to hydrocephalus after large decompressive craniectomy （LDC） in the patients with severe craniocerebral injury （SCI）. Methods The clinical data of 104 patients with SCI undergoing LDC in our hospital from March, 2012 to July, 2015 were analyzed retrospectively. All the patients were followed up for 9 months. Of 104 patients with SCI, 24 suffered from hydrocephalus and 80 not. The risk factors related to postoperative hydrocephalus were analyzed. Results The univariate analysis suggested that the factors related to the hydrocephalus after LDC included the age, ventricular hemorrhage, coma, subdural hematoma, bone window area, bilateral decompressive craniectomy, repair of skull defects in early phase and GCS score in the patients with SCI. The multiviate logistic regression analysis suggested that the independent risk factors for hydrocephalus after LDC were age≥50 years, ventricular hemorrhage, coma, subdural hematoma, bone window area≥120 cm2, bilateral decompressive craniectomy, no repair of skull defects in early phase and GCS score of 3~5 points in the patients with SCI （P〈0.05）. Conclusion There are many risk factors for hydrocephalus after LDC in the patients with SCI, including age, ventricle hemorrhage, coma, subdural hematoma, bone window area, bilateral decompression, Skull defect repair surgery. The appropriate measures should be given to reduce the incidence of hydrocephalus.