重型颅脑损伤患者大骨瓣减压术后发生脑膨出的相关因素分析

Influencing factors of encephalocele after large bone flap decompression in patients with severe craniocerebral injury

目的探讨重型颅脑损伤患者在接受大骨瓣减压术(LDC)后发生脑膨出的相关因素。方法选取2017年2月至2018年11月行大骨瓣减压术的重型颅脑损伤患者133例为研究对象。统计其术后脑膨出发生情况,并将术前格拉斯哥昏迷评分(GCS)、中线移位>1 cm、基底池消失、术中人工硬膜减张缝合、术后颅内感染、术后迟发型脑出血、术后脑积水纳入相关性分析。结果 133例患者LDC术后共计发生脑膨出90例,发生率为67.67%;单因素分析显示,患者年龄、性别、中线移位>1 cm、基底池消失、术后脑积水与LDC术后脑膨出发生率并无明显相关性(P>0.05)。患者术前GCS评分、术中人工硬膜减张缝合、术后颅内感染、术后迟发型脑出血均是影响重型颅脑损伤患者LDC术后发生脑膨出的相关因素(P<0.05)。多因素分析显示,术后脑组织感染与脑膨出的发生无关(P>0.05),术前GCS评分、术中硬膜减张缝合、术后迟发型脑出血是影响LDC术后脑膨出的独立危险因素(P<0.05)。结论术前GCS评分、术中是否行硬膜减张缝合、术后迟发型出血均是影响术后脑膨出发生的重要因素,建议对此类患者应加强术前评估和术后监测,以及时对患者进行针对性干预,提高手术治疗效果。

Objective To investigate the related factors of encephalocele in patients with severe craniocerebral injury after large bone flap decompression(LDC). Methods A total of 133 patients with severe craniocerebral injury treated by decompression of large bone flap from February 2017 to November 2018 were selected as the objects of study. Statistics on the occurrence of brain bulging after surgery, and preoperative Glasgow coma score(GCS), midline shift > 1 cm, disappearance of basal pool, intraoperative manual dural subtraction suture, postoperative intracranial infection, postoperative delayed cerebral hemorrhage, postoperative hydrocephalus was included in the correlation analysis. Results There were 90 cases of encephalocele after LDC in 133 patients, the incidence was 67.67%. Univariate analysis showed that age, sex, midline shift > 1 cm, disappearance of basal cistern, hydrocephalus after operation were not significantly correlated with the incidence of encephalocele after LDC(P>0.05). Preoperative GCS score, intraoperative artificial dural relaxation suture, intracranial infection and delayed intracerebral hemorrhage were all related factors affecting the occurrence of encephalocele in patients with severe craniocerebral injury after LDC(P<0.05).Multivariate analysis showed that there was no relationship between brain infection and encephalocele(P>0.05).Preoperative GCS score, intraoperative dural suture and delayed intracerebral hemorrhage were independent risk factors for encephalocele after LDC(P<0.05). Conclusions Preoperative GCS score, dural subtraction suture during surgery, and delayed postoperative hemorrhage are all important factors that affect the occurrence of post-operative brain bulging. It is recommended that preoperative evaluation and postoperative monitoring should be strengthened in such patients to provide timely targeted intervention and improve the effect of surgical treatment.