重型颅脑损伤单侧去骨瓣减压术后继发脑积水的危险因素分析

Risk factors of secondary hydrocephalus in patients with severe traumatic brain injury after unilateral decompressive craniectomy

目的探讨重型颅脑损伤患者行单侧去骨瓣减压术后继发脑积水的潜在危险因素。方法回顾性分析2016年6月—2019年11月本院神经外科收治并行去骨瓣减压术的重型颅脑损伤患者的临床资料。采用单因素分析和多因素Logistics回归分析患者性别、年龄、致伤类型、蛛网膜下腔出血、是否开放性颅脑损伤、脑室出血、颅内感染、术前中线移位距离、减压窗最上界与中线之间距离、减压窗下界与颧弓之间的距离与去骨瓣减压术后继发脑积水的关系。结果单因素分析显示颅内感染、脑室出血、术前中线移位距离、减压窗最上界与中线之间距离、减压窗下界与颧弓之间的距离在两组间的差异具有统计学意义(P<0.05);而年龄、性别、是否蛛网膜下腔出血、致伤类型、是否开放性在两组间的差异无统计学意义(P>0.05)。多因素分析显示颅内感染(OR=11.510,95%CI:1.033-128.257,P=0.037)、脑室出血(OR=12.248,95%CI:1.324-113.340,P=0.027)、减压窗最上界与中线之间距离(OR=0.072,95%CI:0.006-0.906,P=0.032)、减压窗下界与颧弓之间的距离(OR=0.087,95%CI:0.008-0.951,P=0.035)为继发脑积水发生的独立危险因素。结论重型颅脑损伤患者术前脑室出血、术后颅内感染、减压窗边界过靠近中线与颧弓促进去骨瓣减压术后继发脑积水的发生。

Objective To explore the potential risk factors of secondary hydrocephalus in patients with severe traumatic brain injury after unilateral decompressive craniectomy.Methods The clinical data of the patients with severe traumatic brain injury who underwent unilateral decompressive craniectomy at the department of neurosurgery in the affiliated hospital of Putian University from June 2016 to November 2019 were retrospectively analyzed.The relationship between gender,age,type of injury,subarachnoid hemorrhage,open injury,intraventricular hemorrhage,intracranial infection,preoperative midline displacement distance,the distance between the upper and midline of decompression window,the distance between the lower boundary of decompression window and zygomatic arch and the secondary hydrocephalus after decompressive surgery were analyzed by univariate analysis and multivariate logistic regression.Results Univariate analysis showed that there were significant differences between the two groups(P<0.05)in intracranial infection,intraventricular hemorrhage,preoperative midline displacement distance,the distance between the top of decompression window and midline,the distance between the bottom of decompression window and zygomatic arch,but there were no significant differences in age,gender,whether subarachnoid hemorrhage,type of injury,and whether openness between the two groups(P>0.05).Multivariate analysis showed intracranial infection(OR=11.510,95%CI:1.033-128.257,P=0.037),intraventricular hemorrhage(OR=12.248,95%CI:1.324-113.340,P=0.027),distance between the upper and middle line of decompression window(OR=0.072,95%CI:0.006),the distance between the lower boundary of decompression window and zygomatic arch(OR=0.087,95%CI:0.008-0.951,P=0.035)was the independent risk factors of secondary hydrocephalus.Conclusions The occurrence of secondary hydrocephalus after decompressive craniectomy could be promoted by intraventricular hemorrhage before operation,intracranial infection after operation,border of decompression window close to midline and zygomatic arch.