创伤性颅脑损伤术后并发脑积水危险因素的巢式病例对照研究

Risk factors of postoperative complicating hydrocephalus in patients with severe craniocerebral injury:a nested case-control study

目的探讨创伤性颅脑损伤术后并发脑积水的相关危险因素。方法选取2018年12月至2019年12月该院神经外科收治的创伤性颅脑损伤术后患者275例作为研究对象,其中发生术后脑积水患者41例(14.9%)。采用巢式病例对照临床研究方法将41例患者作为观察组,按1∶5比例匹配205例未发生脑积水患者作为对照组,进行单因素分析和多因素回归分析,探讨发生脑积水的危险因素。结果2组患者年龄、合并脑室出血及硬膜下血肿、格拉斯哥昏迷评分(GCS)、入院时昏迷、骨窗面积比较,差异均有统计学意义(P<0.05);患者年龄大于或等于50岁、合并硬膜下血肿、入院时GCS 6~8分、入院时昏迷、骨窗面积大于或等于120 cm 2是创伤性颅脑损伤术后并发脑积水的独立危险因素(优势比=0.407、0.298、0.252、0.289、0.293,95%可信区间:0.169~0.982、0.135~0.656、0.111~0.576、0.130~0.643、0.124~0.693)。结论创伤性颅脑损伤术后并发脑积水的危险因素较多且机制复杂,围术期应综合考虑患者年龄、是否合并硬膜下血肿、GCS、是否存在昏迷及术中骨窗面积大小等因素采取相应措施以降低脑积水发生率。

Objective To explore the related risk factors of postoperative complicating hydrocephalus in traumatic brain injury.Methods A total of 275 patients with traumatic craniocerebral injury treated in this hospital from December 2018 to December 2019 were selected as the research subjects,including 41 cases(14.9%)developed postoperative hydrocephalus.The nested case-control clinical study method was adopted.The 41 cases served as the observation group,and 205 cases without hydrocephalus were matched as the control group according to the ratio of 1∶5.The univariate analysis and multivariate regression analysis were performed to explore the risk factors of hydrocephalus occurrence.Results The age,complicating intraventricular hemorrhage and subdural hematoma,GCS score,coma at admission,and bone window area had statistical differences between the two groups(P<0.05);the age≥50 years old,complicating subdural hematoma,GCS score 6-8 points at admission,coma at admission,and bone window area≥120 cm were the independent risk factors of complicating hydrocephalus after traumatic craniocerebral injury(OR:0.407,0.298,0.252,0.289,0.293,95%CI:0.169-0.982,0.135-0.656,0.111-0.576,0.130-0.643,0.124-0.693).Conclusion The risk factors of complicating hydrocephalus after traumatic craniocerebral injury are many,moreover its mechanism is complex.In the perioperative period,the factors such as the patient′s age,whether complicating subdural hematoma,GCS score,whether existing coma and the intraoperative bone window area should be comprehensively considered to adopt the corresponding measures to reduce the incidence rate of hydrocephalus.