重型颅脑损伤患者去骨瓣减压术后并发脑膨出的危险因素分析

Risk Factors Analysis of Encephalocele after Decompressive Craniectomy in Patients with Severe Craniocerebral Injury

目的探讨重型颅脑损伤患者去骨瓣减压术后并发脑膨出的危险因素。方法选取2016年9月至2018年9月在北京市大兴区人民医院就诊并采用去骨瓣减压术治疗的102例重型颅脑损伤患者作为研究对象,记录患者基础临床资料,研究格拉斯哥昏迷量表(GCS)评分、中线移位≥1 cm、颅内感染、基底池消失、未人工硬膜减张缝合、术后脑积水、迟发型出血与脑膨出发生之间的关系。结果 102例重型颅脑损伤患者中,脑膨出患者77例,非脑膨出患者25例。脑膨出组GCS评分3~5分、中线移位≥1 cm、颅内感染、基底池消失、未人工硬膜减张缝合、迟发型出血比例高于非脑膨出组(P <0. 05)。GCS评分(OR=1. 835,95%CI 1. 013~3. 339,P=0. 041)、未人工硬膜减张缝合(OR=1. 891,95%CI 1. 065~3. 351,P=0. 027)和迟发型出血(OR=2. 130,95%CI 1. 129~4. 116,P=0. 019)是患者术后脑膨出的危险因素。结论手术后迟发型出血、未人工硬膜减张缝合和GCS评分低是重型颅脑损伤患者去骨瓣减压术后脑膨出发生的危险因素。

Objective To explore the risk factors of cerebral bulging in patients with severe craniocerebral injury after decompressive craniectomy. Methods 102 patients with severe craniocerebral injury who were treated in People’s Hospital of Beijing Daxing District from Sep. 2016 to Sep. 2018 and treated with decompressive craniectomy were selected as subjects. The basic clinical data of the patients were recorded to study the relationship between Glasgow coma scale( GCS)score,midline shift ≥ 1 cm,intracranial infection,disappearance of basal cistern,artificial dural decompression suture,postoperative hydrocephalus,delayed hemorrhage and encephalocele. Results of the no patients with severe craniocerebral injury,77 in the cerebral bulging,25 in non cerebral bulging. The GCS score of encephalocele group was 3-5 points,midline shift≥1 cm,intracranial infection,disappearance of basal cistern,suture without artificial dura decompression and delayed bleeding were higher than that of non encephalocele group( P < 0. 05). GCS score( OR = 1. 835,95% CI 1. 013-3. 339,P = 0. 041),no artificial dural suture( OR = 1. 891,95 % CI 1. 065-3. 351,P = 0. 027) and delayed type bleeding( OR = 2. 130,95% CI 1. 12-4. 116,P = 0. 019) were risk factor for postoperative cerebral bulging. Conclusion Delayed hemorrhage after surgery,unscheduled suture and GCS low scores are independent risk factors for cerebral bulging after decompressive craniectomy in patients with severe craniocerebral injury.