重型颅脑创伤后脑积水形成的多因素分析  

Influencing factors for posttraumatic hydrocephalus after severe traumatic brain injury

作　　者：刘展[1] 游潮[2] 焦庆芳[1] 李松[1] 

机构地区：[1]郑州人民医院神经外科,450000 [2]四川大学华西医院神经外科

出　　处：《中华临床医师杂志（电子版）》2011年第23期6965-6969,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨影响重型脑创伤后脑积水形成的相关因素,为临床防治提供理论依据。方法对收治的符合条件的139例重型颅脑外伤患者进行回顾性研究,分为脑积水组和非脑积水组。对年龄、性别、受伤当时GCS评分、昏迷时间、颅内出血的部位和时间、去骨瓣减压、蛛网膜下腔出血和腰椎持续外引流与脑积水之间的关系进行单因素和Logistic逐步回归法多因素分析。结果 19.42%的患者发生了脑积水。通过Logistic逐步回归分析从9个因素中筛选出年龄(P=0.010)、去骨瓣减压(P=0.033)、蛛网膜下腔出血(P=0.000)和腰大池持续脑脊液外引流(P=0.000)为影响脑脊液发生的相关因素,其中腰大池持续脑脊液外引流为保护性因素。结论年龄增大、去骨瓣减压、蛛网膜下腔出血促使创伤后脑积水产生的重要因素,而外伤后早期行腰大池持续脑脊液外引流可明显减少脑积水的产生。Objective To study the influencing factors for posttraumatic hydrocephalus(PTH) in patients with severe traumatic brain injury and provide theoretical basis for clinical work.Methods Retrospective study was made on 139 patients with severe traumatic brain injuries.Two groups including hydrocephalus group and non-hydrocephalus group was built.Age,sex,GCS Scoring,timing of coma,volume and position of intracranial hematoma,decompressive craniectomy,subarachnoid hemorrhage and influence of continuous lumbar drainage of cerebrospinal fluid were studied to determine the relationship between the related factors and hydrocephalus.Multiple factor analysis was done with Logistic regression.Results PTH was found in 19.42% of patients.Age(P=0.010),decompressive craniectomy(P=0.033),subarachnoid hemorrhage(P=0.000) and continuous lumbar drainage of cerebrospinal fluid(P=0.000) were screened out from nine factors as the influencing factors for posttraumatic hydrocephalus.Continuous lumbar drainage of cerebrospinal fluid was the protective factors.Conclusions Age,decompressive craniectomy,subarachnoid hemorrhage are influencing factors for the forming of PTH after severe traumatic brain injury.Continuous lumbar drainage of cerebrospinal fluid can greatly reduce the incidence of PTH.

关 键 词：脑积水 颅脑损伤 蛛网膜下腔出血 去骨瓣减压 

分 类 号：R651.1[医药卫生—外科学]