交通性脑积水脑室腹腔分流术后迟  

Clinical characteristics and risk factors of delayed intracranial hemorrhage after ventriculoperitoneal shunt in traffic hydrocephalus

作　　者：祁小龙 蓝佛琳 林志钦 郭东斌 黄俊龙 刘天庆 卢靖 Qi Xiaolong;Lan Folin;Lin Zhiqin;Guo Dongbin;Huang Junlong;Liu Tianqing;Lu Jing(Department of Neurosurgery,Longyan First Hospital Affiliated to Fujian Medical University,Longyan 364000,China)

机构地区：[1]福建医科大学附属龙岩第一医院神经外科,364000

出　　处：《中华神经医学杂志》2020年第1期48-53,共6页Chinese Journal of Neuromedicine

摘　　要：目的探讨交通性脑积水患者行脑室腹腔分流术后发生的迟发性颅内出血(DICH)的临床特点及相关危险因素。方法将龙岩第一医院神经外科自2012年1月至2018年8月收治的176例因颅脑外伤、高血压脑出血、脑肿瘤或颅内动脉瘤破裂出血治疗后继发交通性脑积水而行脑室腹腔分流术的患者,按术后有无发生DICH分为发生DICH组和未发生DICH组。分析DICH患者的基本临床特点,包括发生率、发生时间及出血部位等,并采用单因素分析比较2组间年龄、性别、住院时间、伴发疾病、既往手术史、术后硬膜下积液及穿刺道水肿发生率、2周内下调分流管阀门压力史等资料的差异,采用多因素Logistic回归分析进一步明确DICH的独立危险因素。结果176例患者中术后发生DICH者共23例(13.07%),发生时间为术后2~11 d,表现为硬膜下、分流管脑室端穿刺道和(或)脑室内的1个或多个部位出血。单因素分析显示发生DICH组与未发生DICH组间在术后硬膜下积液发生率、2周内下调分流管阀门压力史方面差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示术后硬膜下积液、2周内下调分流管阀门压力史是DICH的独立危险因素(OR=4.516,95%CI:1.555~13.110,P=0.006;OR=5.352,95%CI:1.987~14.414,P=0.001)。结论脑室腹腔分流术后2周内是DICH高发期,对于伴有术后硬膜下积液、2周内下调分流管阀门压力的患者应密切监护以预防DICH的发生。Objective To analyze the clinical features and risk factors of delayed intracranial hemorrhage(DICH)after ventriculoperitoneal shunt(VPS)in patients with communicating hydrocephalus.Methods One hundred and seventy-six patients with ventriculoperitoneal shunt due to communicating hydrocephalus secondary to craniocerebral trauma,hypertensive intracerebral hemorrhage,brain tumor or intracranial aneurysm rupture hemorrhage,admitted to our hospital from January 2012 to August 2018,were selected in our study;these patients were divided into DICH group and non-DICH group according to whether or not DICH occurred.The clinical features,including incidence,time and location of DICH,were analyzed.The differences of age,gender,length of stay,concomitant diseases,previous operation history,incidences of subdural effusion and puncture canal edema after ventriculoperitoneal shunt,and history of down-regulating shunt valve within 2 weeks between the two groups were compared by univariate analysis.The independent risk factors for DICH were further assessed using multivariable Logistic regression.Results Among 176 patients,23(13.07%)had DICH;2-11 d after surgery,DICH appeared,manifesting as subdural,ventriculoventricular end canal and/or hemorrhage in one or more areas of the ventricle.There were significant differences in incidence of subdural effusion and history of down-regulating shunt valve within 2 weeks between the two groups(P<0.05).Multivariate Logistic regression analysis showed that subdural effusion after surgery and down-regulation of shunt valve pressure within 2 weeks after ventriculoperitoneal shunt were independent risk factors for DICH(OR=4.516,95%CI:1.555-13.110,P=0.006;OR=5.352,95%CI:1.987-14.414,P=0.001).Conclusion High incidence of DICH mighty be noted within two weeks of ventriculoperitoneal shunt;subdural effusion and pressure reduction of shunt valve within 2 weeks are independent risk factors for DICH,which needs close monitoring and clinical intervention.

关 键 词：迟发性颅内出血 交通性脑积水 脑室腹腔分流术 危险因素 

分 类 号：R651[医药卫生—外科学]