重型颅脑外伤术后脑积水的高危因素及临床疗效分析

Risk factors and clinical curative effect of postoperative hydrocephalus after severe craniocerebral trauma

目的探究导致重型颅脑外伤患者术后发生脑积水的高危因素,分析其治疗方法并观察临床治疗效果。方法择取2015年1月~2016年12月期间于笔者所在医院以开颅去骨瓣减压术进行重型颅脑外伤治疗并在术后发生脑积水的40例患者,设其为研究组;择取同期于笔者所在医院以开颅去骨瓣减压术进行重型颅脑外伤治疗但在术后未发生脑积水的40例患者,设其为对照组。对比两组患者的临床基本资料,总结引发术后脑积水的高危因素,并观察临床疗效。结果血肿部位(硬膜下、脑内)、蛛网膜下腔出血、脑室出血、行腰椎穿刺脑脊液置换操作、入院时的GCS评分低、在术中未行硬脑膜缝合是导致术后发生脑积水的高危因素,研究组与对照组在上述高危因素上有着明显的不同,差异有统计学意义(P<0.05)。研究组患者行"脑室-腹腔"分流术,30d内恢复清醒状态,体温正常,无语言障碍。结论临床应为重型颅脑外伤患者进行术后脑积水高危因素的评估,预防脑积水的发生;若已发生,则可通过使用"脑室-腹腔"分流术来缓解患者的病情。

Objective To explore the high risk factors of hydrocephalus in patients with severe craniocerebral trauma, and to analyze the treatment and observe the clinical therapeutic effect. Methods Forty patients with severe craniocerebral trauma treated with craniotomy and decompression in author＇s hospital from January 2015 to December 2016 were enrolled in this study and as the study group. Forty patients with the same period in author＇s hospital treated with craniotomy flap decompression surgery but no postoperative hydrocephalus were selected and as the control group. The clinical data of the two groups were compared, the risk factors of postoperative hydrocephalus were summarized, and the clinical efficacy were observed. Results The high risk factors for hydrocephalus included hematoma site （subdural and brain）, subarachnoid hemorrhage, ventricular hemorrhage, lumbar puncture cerebrospinal fluid replacement operation, admission GCS score was low, no dural suture in cerebral dura mater were performed during the operation. The risk factors of hydrocephalus were significantly different between the study group and the control group in the above-mentioned risk factors, the difference was statistically significant （P 〈 0.05）. The patients of study group were treated with ＂ventricle - abdominal＂ shunt, and restored the awake state within 30 days, the temperature was normal, no language barriers. Conclusion It is necessary to evaluate the high risk factors of postoperative hydrocephalus in patients with severe craniocerebral trauma, and to prevent the occurrence of hydrocephalus. If it has occurred, it can be used to alleviate the condition of the patients by using ＂ventricle- peritoneal＂.