重度颅脑损伤行去骨瓣减压术后并发脑积水的相关因素分析

Analysis of Related Factors of Hydrocephalus after Decompressive Craniectomy for Severe Craniocerebral Injury

目的 探讨重度颅脑损伤(severe traumatic brain iniury,STBI)行去骨瓣减压术后并发脑积水的相关危险因素。方法 回顾性收集2016—2020年辽宁省健康产业集团抚矿总医院收治的STBI病例213例,将去骨瓣减压术后出现积水的74例患者纳入观察组,将其余139例纳入对照组。比较两组患者的一般情况、术前影像学检查和手术情况,筛选并发脑积水的危险因素。结果 多因素Logistic回归分析显示,术中骨窗面积、二次手术、大面积脑梗死、颅内血肿、脑挫裂伤、蛛网膜下腔出血是STBI去骨瓣减压术后并发脑积水的独立危险因素(P<0.05)。结论 脑积水是STBI去骨瓣减压术后常见的并发症之一,对于存在脑积水危险因素的患者,围手术期应该严密观察患者病情变化,保证患者顺利度过创伤危险期。

Objective To investigate the risk factors of hydrocephalus after decompressive craniectomy for severe traumatic brain injury(STBI). Methods A total of 213 cases of STBI treated in Fukuang General Hospital of Liaoning health industry group from 2016 to 2020 were collected retrospectively. Seventy-four patients with hydrops after bone flap decompression were included in the observation group, and the remaining 139 cases were as the control group. The general condition, preoperative imaging examination and operation of the two groups were compared to screen the risk factors of hydrocephalus. Results Multivariate logistic regression analysis showed that intraoperative bone window area, secondary operation, large-area cerebral infarction, intracranial hematoma, cerebral contusion and laceration and subarachnoid hemorrhage were independent risk factors for hydrocephalus after STBI bone flap decompression(P<0.05). Conclusion Hydrocephalus is one of the common complications after STBI bone flap decompression. For patients with hydrocephalus risk factors, the changes of the patient’s condition should be closely observed during the perioperative period to ensure that the patient can pass the trauma risk period smoothly.