分流手术时机在创伤性脑积水治疗中的意义及相关危险因素分析  

Significance of shunt operation timing in the treatment of traumatic hydrocephalus and analysis of related risk factors

作　　者：陈楠 鲍风 江幸福 叶雷 程宏伟[1] CHEN Nan;BAO Feng;JIANG Xingfu;YE Lei;CHENG Hongwei(Department of Neurosurgery,The First Affiliated Hospital of Anhui Medical University,Hefei 230022,China)

机构地区：[1]安徽医科大学第一附属医院神经外科,合肥230022 [2]安徽省中医药大学第一附属医院神经外科,合肥230032

出　　处：《实用医学杂志》2020年第2期190-194,共5页The Journal of Practical Medicine

基　　金：安徽省教育厅高校优秀拔尖人才学术资助项目(编号：gxbjZD11,2018.01-2020.12)

摘　　要：目的研究创伤性脑积水(post⁃traumatic hydrocephalus,PTH)的临床特征,分析与其发病相关的危险因素,并探讨手术治疗时机对患者结局的影响。方法回顾性分析2015年1月至2017年12月安徽省中医院神经外科创伤性颅脑损伤(traumatic brain injury,TBI)数据库的641例TBI患者的资料,根据纳入和排除标准分为PTH组与无PTH组(nPTH),收集两组患者的资料,采用统计学方法进行分析;并进一步将分流手术患者分为早期分流组及晚期分流组,通过比较两组患者的疗效,评估分流手术时机对患者治疗结局的影响。结果(1)PTH组患者具有更多颅内占位的影像学证据(P<0.001),行手术治疗的病例更多(P<0.001),急性期住院时间也明显延长(P<0.001)。(2)在接受脑室-腹腔分流术(ventriculoperitoneal shunt,VPS)的PTH患者中,早期行分流手术与更好的治疗结局有关,并且可以独立预测更高的功能独立性量表(functional independent measures,FIM)评分(P<0.001),和更短的创伤后遗忘症(post⁃traumatic amnesia,PTA)的持续时间(P=0.027)。结论早期有颅内占位表现和行开颅减压手术的TBI患者更容易进展为PTH;在行分流手术的PTH患者中,早期手术预示更好的治疗结局。Objective To study the clinical characteristics of post⁃traumatic hydrocephalus(PTH),analyze the risk factors associated with its onset,and investigate the effect of surgical treatment timing on patient outcomes.Method Retrospective analysis was performed on 641 patients with traumatic brain injury(TBI)in the TBI database from January 2015 to December 2017 in Anhui Provincial Hospital of Traditional Chinese Medicine.The patients were divided into a PTH group and a Non⁃PTH group(nPTH)according to the inclusion/exclusion criteria.Data of the two groups were collected and analyzed by statistical method.Patients who underwent shunt operation were further divided into an Early Shunt Group and a Late Shunt Group.The effect of the shunt operation timing on the treatment outcomes of patients was evaluated by comparing the efficacy between the two groups.Results(1)PTH group had more imaging evidence of intracranial space⁃occupying lesion(P<0.001),more cases of surgical treat⁃ment(P<0.001),and significantly longer hospital stay in the acute phase(P<0.001).(2)For PTH patients who underwent the ventriculoperitoneal shunt(VPS),early shunt operation was associated with better outcomes;could independently predict higher scores of the functional independence measures(FIM)(P<0.001);had a short⁃er duration of post⁃traumatic amnesia(PTA)(P=0.027).Conclusions TBI patients with early manifestation of intracranial space⁃occupying lesion who underwent craniotomy were more likely to progress to PTH;PTH patients who underwent shunt operation,early operation predicted better outcomes.

关 键 词：创伤性脑积水 创伤性颅脑损伤 脑室腹腔分流术 危险因素 神经状态进展 

分 类 号：R320.2720[医药卫生—人体解剖和组织胚胎学]