去骨瓣减压骨瓣面积与颅脑外伤后慢性脑积水发生的关系  

The relationship bebveen the area of decompressed bone flap and the occurrence of chronic hydrocephalus after craniocerebral injury

作　　者：孔成[1] 厉航 童民锋[2] Kong Cheng

机构地区：[1]浙江省磐安县人民医院,322399 [2]浙江省金华市中心医院,321000

出　　处：《浙江临床医学》2019年第12期1609-1611,共3页Zhejiang Clinical Medical Journal

摘　　要：目的通过回顾性分析外伤性颅脑损伤后脑积水的相关资料,探讨去骨瓣减压的骨瓣面积与慢性脑积水发生的关系.方法回顾性分析2008年1月至2018年1月期间于金华市中心医院和磐安县人民医院神经外科行单侧去骨瓣减压术且病例资料完整的患者98例.记录患者的临床资料包括年龄、性别、慢性病病史、病情严重程度等资料.根据是否发生脑积水分为脑积水组和非脑积水组,比较两组在年龄、性别比例、高血压病史、颅底骨折、入院时格拉斯哥昏迷评分(GCS)、蛛网膜下腔出血、脑室出血以及骨瓣相对面积等8个相关指标上有无差异.对纳入的可能潜在危险因素进行单因素χ2检验,比较两组患者各危险因素发生频率是否存在统计学差异.结果结果显示,患者年龄、性别比例、高血压病史、及颅底骨折等潜在危险因素在两组患者之间的发生频率均无统计学差异(P>0.05).而GCS、蛛网膜下腔出血、脑室出血以及骨瓣相对面积患者在病例组中的频率显著高于对照组(P<0.05).Logistic回归方程结果显示,GCS评分和骨瓣相对面积是发生脑积水的独立因素.结论入院时GCS评分和骨瓣相对面积是外伤后脑积水的独立风险因素.针对上述危险因素,在救治颅内高压时,慎重选择去骨瓣面积,减少脑积水发生率,改善颅脑损伤患者的预后有重要意义.Objective Through retrospective analysis of the related data of hydrocephalus after traumatic brain injury,the relationship between the area of bone flap decompression and the occurrence of chronic hydrocephalus was discussed.Methods 98 patients admitted to our hospital in recent years with complete data were selected as research subjects.The two groups were compared with 8 related indexes,such as age,sex ratio,history of hypertension,skull base fracture,GCS,subarachnoid hemorrhage,ventricular hemorrhage at admission,and relative area of bone flaps.The potential risk factors were analyzed by chi-square test or student—t test to compared the difference between the two groups.Results The results showed that there were no significant difference in the frequency of potential risk factors among the two groups,such as age,sex ratio,diabetes history,hypertension history,and skull base fracture.But the frequency of GCS,subarachnoid hemorrhage,intraventricular hemorrhage,and relative area of bone flaps in the case group was significantly higher than that in the control group(P<0.05).Logistic regression equation showed that GCS,subarachnoid hemorrhage,and intraventricular hemorrhage were independent factors of hydrocephalus.Conclusion The admission Glasgow coma scores,and relative area of bone flaps are independent risk factors of post—traumatic hydrocephalus.In view of the above risk factors,in the treatment of intracranial hypertension,it is important to carefully select the area of bone flap,reduce the incidence of hydrocephalus and improve the prognosis of patients with craniocerebral injury.

关 键 词：脑外伤 脑积水 骨瓣面积 去骨瓣减压 风险因素 

分 类 号：R65[医药卫生—外科学]