中重型创伤性脑损伤后脑积水发生的危险因素分析  

Risk factors for hydrocephalus after moderate to severe traumatic brain injury

作　　者：曹铖[1] 马继强[2] 梁玉敏[2] 吴伟[1] 高恒[1] 

机构地区：[1]东南大学医学院附属江阴市人民医院脑科中心,214400 [2]上海交通大学医学院附属仁济医院神经外科,上海市颅脑创伤研究所

出　　处：《中华创伤杂志》2016年第7期602-606,共5页Chinese Journal of Trauma

摘　　要：目的探讨中重型创伤性脑损伤（TBI）后脑积水（PTH）发生的危险因素。方法回顾性分析中重型TBI患者183例（中型103例，重型80例）的临床资料，其中男125例，女58例；年龄6～91岁，平均48．23岁。根据是否并发PTH，分为PTH组（34例）和无PYH组（149例）。采用单因素和多因素Logistic回归分析两组性别、年龄、致伤原因、TBI伤情分型、脑室内出血、蛛网膜下腔出血、中线移位、硬脑膜下积液、治疗方法、是否遗留颅骨缺损与PTH发生的相关性；同时进一步分析两组中颅骨缺损患者的骨瓣边界距离（上界及下界）与PTH发生的相关性。结果两组性别、年龄、致伤原因、脑室内出血等与PTH发生无相关性（P〉0．05）；TBI伤情分型、蛛网膜下腔出血、中线偏移程度、硬脑膜下积液、施行开颅手术治疗及遗留颅骨缺损等均与PTH的发生相关（P〈0．05）。蛛网膜下腔出血（OR=6．169）、大脑半球间硬脑膜下积液（OR=31．743）、单侧颅骨缺损（OR=17．602）及双侧颅骨缺损（OR=30．567）与PTH的发生密切相关；单侧颅骨缺损患者的骨瓣下界与颧弓水平距离≤10mm也与PTH发生密切相关（OR=5．500，P〈0．05）。结论蛛网膜下腔出血、大脑半球问硬脑膜下积液及颅骨缺损均是PTH发生的危险因素，其中单侧颅骨缺损患者骨瓣下界过低也是促进PTH发生的因素之一。Objective To investigate the risk factors of posttraumatic hydrocephalus （PTH） in patients with moderate to severe traumatic brain injury （TBI）. Methods Aretrospective study was conducted for 183 patients with moderate to severe TBI （125 males, 58 females; 6-91 years of age, mean 48.23 years）. According the presence of PTH, the patients were allocated into PTH group （ n = 34） and non-PTH group （ n = 149）. Risk factors of PTH were assessed by univariate and logistic regression analysis, including gender, age, injury types, injury severity, intraventricular hemorrhage, subarachnoid hemorrhage, midline shift, subdural effusion, therapeutic strategies and skull defect. Association between the boundaries of skull defect and PTH was determined. Results Between-group differences were not significant regarding age, gender, injury types and intraventricular hemorrhage （ P 〉 0.05 ）, but differed significantly in injury severity, subarachnoid hemorrhage, midline shift, subdural effusion, craniectomy and skull defect （ P 〈 0.05 ）. Further Logistic regression analysis confirmed subarachnoid hemorrhage （ OR = 6.169）, interhemispheric subdural effusion （ OR = 31. 743 ） , and unilateral （ OR = 17. 602 ） and bilateral（ OR = 30. 567）skull defects were risk factors of PTH. Of the patients with unilateral skull defect following decompressive craniectomy, the inferior limit ≤10 mm from the zygomatic arch also played a role in the development of PTH （ OR = 5. 500, P 〈 0.05 ）. Conclusions Subarachnoid hemorrhage, interhemispheric subdural effusion and skull defect are risk factors of PTH. Unilateral skull defects with the inferior limit too close to the zygomatic arch can predispose to the development of PTH.

关 键 词：脑积水 危险因素 减压术 外科 硬膜下积液 

分 类 号：R651.15[医药卫生—外科学]