创伤性脑损伤后脑积水发生的危险因素分析

Analysis on risk factors for hydrocephalus after traumatic brain injury

目的探讨创伤性脑损伤(TBI)后发生创伤后脑积水(PTH)的危险因素。方法采用回顾性病例对照研究分析2007年1月—2017年1月深圳市第二人民医院收治的794例急性TBI患者的临床资料,其中男639例,女155例;年龄1~90岁[(40.5±18.6)岁]。随访观察患者1年,46例为PTH组,748例为非PTH组。分析两组患者入院格拉斯哥昏迷评分(GCS)、瞳孔反射、CT检查是否有中线移位和环池受压、是否伴蛛网膜下腔出血(SAH)、手术与否及手术方式、去骨瓣与否、术后有无积液发生、颅内感染发生与否、颅骨修补时机等指标,经过单因素和Logistic回归分析,最终判断发生PTH的危险因素。结果46例患者(5.8%)发生PTH。单因素分析结果显示GCS、中线移位、去骨瓣减压、硬膜下积液、颅骨修补时机和SAH与PTH的发生密切相关(P<0.05或0.01)。Logistic回归分析提示,低GCS(OR=3.778)、去骨瓣减压(OR=2.508)、硬膜下积液(OR=2.269)、颅骨修补时机≥3个月(OR=10.478)和SAH(OR=23.391)与PTH显著相关(P<0.05或0.01)。结论PTH是TBI后常见且影响预后的重要并发症,危险因素包括低GCS、去骨瓣减压、硬膜下积液、延迟颅骨修补≥3个月和SAH。

Objective To investigate the risk factors for post-traumatic hydrocephalus(PTH)after traumatic brain injury(TBI).Methods A retrospective case control analysis was made on the clinical data of 794 patients with acute TBI admitted to Shenzhen Second People's Hospital between January 2007 and January 2017.There were 639 males and 155 females,aged 1-90 years[(40.5±18.6)years].All patients were followed up for 1 years,and the patients were divided into PTH group(n=46)and non-PTH group(n=748)according to their prognosis.The following information including Glasgow coma score(GCS)on admission,pupil reflex,midline shift and cistern compression,subarachnoid hemorrhage(SAH),operation method,decompressive craniectomy,hydrocephalus after operation,intracranial infection,timing of cranioplasty were analyzed using univariate analysis and Logistic regression.Results PTH occurred in 46 patients(5.8%).Univariate analysis showed that GCS,midline shift,decompressive craniectomy,subdural effusion,timing of cranioplasty and SAH were significantly related to PTH(P<0.05 or 0.01).Logistic regression identified low GCS(OR=3.778),decompressive craniectomy(OR=2.508),subdural effusion(OR=2.269),timing of cranioplasty(≥3 months)(OR=10.478)and SAH(OR=23.391)as the independent risk factors for PTH(P<0.05 or 0.01).Conclusion PTH is a common serious complication of traumatic brain injury,affected by low GCS,decompressive craniectomy,subdural effusion,delayed cranioplasty and SAH.