重型颅脑损伤术后发生脑积水的相关因素分析

Analysis of related factors of hydrocephalus after operation in patients with severe traumatic brain injury

目的:探讨重型颅脑损伤患者术后发生脑积水相关因素分析。方法:选取2010-01—2016-01期间延安大学附属医院收治的196例重型颅脑损伤患者,将其分为脑积水组(29例)和非脑积水组(167例),采用χ2检验分析比较两组患者年龄、GCS评分、硬膜下血肿、开放性颅脑损伤、脑室出血等因素,多因素Logistic回归法分析影响脑积水发生的危险因素。结果:χ2检验显示,两组患者在入院时年龄≥50岁、GCS评分3~5分、硬膜下血肿、开放性颅脑损伤、脑室出血、中线移位程度、早期去大骨瓣减压、硬膜敞开、手术时间、双侧去骨瓣减压、腰穿脑脊液置换、早期颅骨缺损修补术等方面比较,差异有统计学意义(P<0.05);多因素Logistic回归分析提示,入院时硬膜下血肿、脑室出血、中线移位程度、早期去大骨瓣减压、硬膜敞开、双侧去骨瓣减压为危险因素,腰穿脑脊液置换、早期颅骨缺损修补术为保护因素,有统计学意义(P<0.05)。结论:重型颅脑损伤患者存在硬膜下血肿、脑室出血、中线移位程度≥12mm、早期去大骨瓣减压、硬膜敞开、双侧去骨瓣减压等情况时,要警惕术后发生脑积水的可能。

Objective：To investigate the risk factors related to hydrocephalus after large decompressive craniectomy in patients with severe traumatic brain injury（sTBI）.Method：A total of 196 sTBI patients admitted to our hospital from January 2010 to January 2016 were divided into hydrocephalus group（n=29）and non-hydrocephalus group（n=167）.χ2 test was used to compare the age,GCS score,subdural hematoma,open craniocerebral injury,ventricular hemorrhage and other factors between the two groups,and multivariate Logistic regression was used to analyze the risk factors affecting the occurrence of hydrocephalus.Result：χ2 test showed that there were significant differences in age≥50,GCS score of 3~5 points,subdural hematoma,open craniocerebral injury,ventricle hemorrhage,the extent of midline shift,early decompressive craniectomy,dura mater opening,duration of operation,bilateral decompression,lumbar puncture cerebrospinal fluid（CSF）replacement,and repair of skull defects in early phase between the two groups（P〈0.05）.The multivariate logistic regression analysis showed that there were also significant differences in above indices between the two groups（P〈0.05）.The risk factors for postoperative hydrocephalus were subdural hematoma,ventricle hemorrhage,the extent of midline shift,early decompressive craniectomy,dura mater opening and bilateral decompression,while the lumbar puncture CSF replacement,repair of skull defects in early phase were protective factor for postoperative hydrocephalus.Conclusion：When patients with sTBI have subdural hematoma,ventricle hemorrhage,midline shift≥12 mm,early decompressive craniectomy,dura mater opening,and bilateral decompression,the possibility of postoperative hydrocephalus should be alerted.