颅脑外伤单侧去骨瓣减压术后发生脑积水的危险因素分析

Analysis on risk factors of post traumatic hydrocephalus in patients with traumatic brain injury underwent unilateral decompressive craniectomy

目的研究脑外伤患者单侧去骨瓣减压术后发生创伤后脑积水的潜在危险因素。方法回顾性分析泗洪县分金亭医院2010年1月—2018年1月165例脑外伤行单侧去骨瓣减压术患者的临床资料。根据患者术后是否发生脑积水分为脑积水组(46例)和无脑积水组(119例);分别对患者的基本资料、影像学特征及手术参数进行单因素和多因素分析。结果通过统计学分析发现,外伤后脑积水与患者的年龄(P=0.008)、骨窗大小(P<0.001)、脑室积血(P=0.025)和术后感染(P=0.001)相关。进一步通过受试者特征曲线分析发现,4种因素综合后的曲线下面积为0.857(95%CI:0.79-0.924)。结论患者的年龄、骨窗面积、脑室积血及术后感染是创伤后脑积水的独立危险因素,并且当4种因素同时存在时应密切观察随访。

Objective To analyze the potential risk factors of post traumatic hydrocephalus(PTH)in patients with brain injury underwent unilateral decompressive craniectomy(DC).Methods The clinical data of patients suffering from traumatic brain injury underwent unilateral DC between Jan 2010 and Jan 2018 in Fen Jinting Hospital were analyzed retrospectively.The patients were divided into PTH group and non-PTH group based on the occurrence of PTH after DC within 3 months.Univariate and multivariable analysis were made between the general information,pre-operative condition,imagine manifestation and sumcal parameters of two groups.Results 183 patients were included in the study.46 of them suffered from PTH after surgery.Statistical analysis revealed that age(P=0.008),area of craniectomy(P<0.001),intraventricular hemorrhage(P=0.025)and postoperative intracranial infection(P=0.001)were associated with PTH.Moreover receiver operating characteristic curves were created and the area under the curve(AUC)was 0.857 for the combined all four independent factors(95% confidence interval:0.79-0.924).Conclusion The age,area of craniectomy,intraventricular hemorrhage and postoperative intracranial infection were independent risk factors of hydrocephalus after DC,and coexisting of all factors should be closely monitored at follow-up assessments.