重型颅脑创伤患者去骨瓣减压术后发生脑积水的影响因素

Influential factors of hydrocephalus in patients with severe craniocerebral trauma after decompressive craniectomy

目的 分析重型颅脑创伤患者去骨瓣减压术治疗后发生脑积水的影响因素。方法 760例重型颅脑损伤去骨瓣减压术患者,根据术后是否发生脑积水分为脑积水组(53例)和非脑积水组(707例),所有患者术后均随访30 d;收集两组患者性别、年龄、格拉斯哥昏迷评分(GCS)、颅骨修补时机、蛛网膜下腔出血(SAH)、瞳孔反射及瞳孔散大、环池情况、硬膜下积液、颅内感染、损伤部位、术后脑室积血及术后昏迷时间等资料,采用多因素logistic回归分析重型颅脑创伤患者去骨瓣减压术治疗后发生脑积水的影响因素。结果 760例重型颅脑创伤患者去骨瓣减压术治疗后发生脑积水53例(6.97%);脑积水组患者GCS 3~8分、中线移位≥10 mm、硬膜下积液、颅骨修补时机≥3个月、SAH、术后昏迷时间≥30 d等指标的发生率均高于非脑积水组(P<0.05);GCS 3~8分、硬膜下积液、颅骨修补时机≥3个月、SAH、术后昏迷时间≥30 d均为重型颅脑创伤患者去骨瓣减压术治疗后发生脑积水的独立危险因素(OR=2.370、2.212、1.960、1.990、2.188,P<0.05)。结论 GCS 3~8分、硬膜下积液、颅骨修补时机≥3个月、SAH、术后昏迷时间≥30 d是重型颅脑创伤患者去骨瓣减压术治疗后发生脑积水的独立危险因素。

Objective To analyze the influential factors behind hydrocephalus after decompressive craniectomy in patients with severe craniocerebral trauma.Methods Seven hundred and sixty patients with severe craniocerebral trauma after decompressive craniectomy were divided into the hydrocephalus group(53 cases)and the non-hydrocephalus group(707 cases)according to whether the patients had hydrocephalus after operation.The data of gender,age,score of Glasgow coma score(GCS),cranial repair time,subarachnoid hemorrhage(SAH),pupil reflex and pupil dilation,circumferential cisterna,subdural effusion,intracranial infection,injury site,the times of postoperative ventricular hematoma,and postoperative coma were collected,and the multivariate logistic regression was adopted to analyse the influential factors behind hydrocephalus after decompressive craniectomy.Results Hydrocephalus occurred after decompressive craniectomy in 53 of 760 patients with severe craniocerebral trauma,and the incidence of hydrocephalus was 6.97%.The results showed that the incidence of the following data of the non-hydrocephalus group were lower than those of the hydrocephalus group with GCS between 3 and 8 points,midline shifts more than 10 mm,the times of subdural effusion and skull repair more than 3 months,and the times of SAH and postoperative coma more than 30 d(P<0.05).GCS between 3 and 8 points,the times of subdural effusion amnd skull repair more than 3 months,and the times of SAH and postoperative coma more than 30 d were independent risk factors behind hydrocephalus in patients with severe craniocerebral trauma after decompressive craniotomy(OR=2.370,2.212,1.960,1.990,2.188;P<0.05).Conclusion GCS between 3 and 8 points,the times of subdural effusion amnd skull repair more than 3 months,and the times of SAH and postoperative coma more than 30 d are independent risk factors behind hydrocephalus in patients with severe craniocerebral trauma after decompressive craniotomy.