颅脑损伤后脑积水患者预后的影响因素

Prognostic factors of hydrocephalus patients after craniocerebral injury

目的分析颅脑损伤后脑积水患者预后的影响因素,预判颅脑损伤患者的预后转归。方法收集2014年6月—2019年6月徐州医科大学附属医院收治的200例颅脑损伤后脑积水患者的临床资料。回顾性分析患者性别、年龄、颅脑损伤原因、入院时格拉斯哥昏迷指数(GCS)评分、瞳孔反应、蛛网膜下腔出血、脑室出血、中线移位、颅内压增高、硬膜下积液情况。对选定因素进行单因素分析,根据结果进行多因素Logistic回归分析,探讨颅脑损伤后脑积水患者预后的影响因素。结果单因素分析结果显示,在预后良好与预后不良患者中,性别与颅脑损伤原因差异无统计学意义(P>0.05),而年龄、入院时GCS评分、瞳孔反应、蛛网膜下腔出血、脑室出血、中线移位、颅内压增高、硬膜下积液差异与颅脑损伤后脑积水患者的预后相关(P<0.05)。多因素分析结果显示,年龄、入院时GCS评分、脑室出血是影响颅脑损伤后脑积水预后的独立危险因素。结论应对高龄、术前GCS评分低的脑积水患者予以高度关注,并制定详细合理的复查计划。合并脑室出血的患者需积极减轻出血。

Objective To investigate the prognostic factors of hydrocephalus patients after craniocerebral injury so as to assess their outcome.Methods Retrospective analysis was performed using clinical data from 200 hydrocephalus patients after craniocerebral injury who were admitted into the Affiliated Hospital of Xuzhou Medical University from June 2014 to June 2019.The following information was collected:patients′gender,age,causes of craniocerebral injury,Glasgow Coma Scale(GCS)score at admission,pupillary response,subarachnoid hemorrhage,ventricular hemorrhage,midline shift,increased intracranial pressure,and subdural effusion.Univariate analysis was performed based on selected factors,and the results were adopted for multivariate logistic regression analysis to explore the prognostic factors of hydrocephalus patients after craniocerebral injury.Results According to univariate analysis,no statistical difference was found in gender and causes of craniocerebral injury between patients with good and poor prognosis(P>0.05).In contrast,age,GCS score at admission,pupillary response,subarachnoid hemorrhage,intraventricular hemorrhage,midline shift,increased intracranial pressure,and subdural effusion were related to the prognosis of hydrocephalus patients after craniocerebral injury(P<0.05).Multivariate analysis indicated that age,GCS score at admission,and intraventricular hemorrhage were the independent risk factors affecting the prognosis of hydrocephalus after craniocerebral injury.Conclusions For elderly patients with hydrocephalus and low GCS score before surgery,high concerns should be drawn,while detailed and reasonable review plans are needed.Patients with ventricular hemorrhage should be actively treated to relieve bleeding.