脑积水脑室穿刺术后继发导管相关性出血的危险因素

Risk factors for catheter-related intracranial hemorrhage in patients with hydrocephalus after ventricular puncture

目的 探讨脑积水脑室穿刺术后继发导管相关性出血的危险因素。方法 回顾性分析2015年4月至2020年7月收治的187例脑积水的临床资料。结果 187例中,120例经枕角穿刺行脑室-腹腔分流术,67例经额角穿刺行脑室外引流术。术后发生导管相关性出血13例,发生率为6.9%;其中枕角穿刺出血7例,额角穿刺出血6例;保守治疗2例,手术治疗11例;出院时GOS评分4~5分7例,2~3分4例,1分2例;出院后随访6个月,GOS评分无明显变化。多因素logistic回归分析显示,颅内压急剧下降(OR=6.39;95%CI 1.67~24.5;P=0.007)、堵管后重新置管(OR=5.45;95%CI 1.45~20.4;P=0.010)、脑室穿刺>3次(OR=10.4;95%CI 2.33~46.6;P=0.002)是导管相关性出血的独立危险因素。结论 导管相关性出血是脑积水脑室穿刺术后较为少见的、严重并发症,围手术期应综合评估,以降低术后出血概率;术后应密切观察病情并及时复查头颅CT,出血量大的病人,预后较差。

Objective To investigate the risk factors for catheter-related intracranial hemorrhage in the patients with hydrocephalus after ventricular puncture. Methods The clinical data of 187 patients with hydrocephalus, of whom 120 patients underwent ventriculoperitoneal shunt through occipital horn puncture and 67 patients underwent extraventricular drainage through frontal horn puncture from April 2015 to July 2020, were retrospectively analyzed. Results Catheter-related intracranial hemorrhage occurred in 13 patients(6.9%), including 7 patients through occipital horn puncture and 6 frontal horn puncture. Two patients received conservative treatment and 11 surgical treatment. On discharge, GOS score of 4~5 was achieved in 7 patients, score of 2~3 in 4 patients,and score of 1 in 2 patients. The follow-up(6 months) showed no significant change in the GOS score. Multivariate logistic regression analysis showed that sharp decrease of intracranial pressure(OR=6.39;95% CI 1.67~24.5;P=0.007), and catheter replacement due to obstruction(OR=5.45;95% CI 1.45~20.4;P=0.010)), and ventricular puncture >3 times(OR=10.4;95% CI 2.33~46.6;P=0.002) were independent risk factors for catheter-related intracranial hemorrhage in the patients with hydrocephalus after ventricular puncture.Conclusions Catheter-related intracranial hemorrhage is a rare and serious complication in the patients with hydrocephalus after ventricular puncture. Comprehensive evaluation should be performed during the perioperative period in order to reduce the risk of postoperative hemorrhage. The prognosis of patients with heavy hemorrhage is poor, so the patient’s condition should be closely observed and CT examination should be performed in time.