颅脑损伤去骨瓣减压术后脑积水危险因素分析及分流时机  

Analysis of risk factors and timing of shunt for hydrocephalus in patients with traumatic brain injury after decompressive craniectomy

作　　者：李龙[1] 杨金庆[1] 薛勇[1] 赵学俊[1] LI Long;YANG Jin-qing;XUE Yong;ZHAO XUE-jun(Deparment of Neurosurgery,Oilfield General Hospital of Puyang City,Puyang 457000,China)

机构地区：[1]濮阳市油田总医院神经外科,河南457000

出　　处：《中国临床神经外科杂志》2020年第9期600-602,共3页Chinese Journal of Clinical Neurosurgery

摘　　要：目的探讨颅脑损伤病人去骨瓣减压术后发生脑积水的危险因素及分流术时机。方法回顾性分析2017年1月~2019年12月去骨瓣减压术治疗的128例颅脑损伤的临床资料。多因素logistic回归分析检验脑积水危险因素。结果128例中,术后发生脑积水28例,发生率为21.9%。多因素Logistic回归分析结果表明,蛛网膜下腔出血、脑室出血、骨窗面积≥7 cm2是颅脑损伤去骨瓣减压术后继发脑积水的独立危险因素(P<0.05)。28例脑积水中,22例行脑室-腹腔分流术,按照分流中位时间的3.5 d分为早期分流组和晚期分流组,各11例;早期分流组术后颅内压改善效果更好(P<0.05),颅内压恢复时间明显缩短(P<0.05);但是两组脑脊液指标和并发症发生率均无统计学差异(P>0.05)。结论脑积水是颅脑损伤去骨瓣减压术后常见并发症,手术治疗前应充分评估脑积水发生的因素,一旦发生脑积水应查明原因并早期进行分流手术治疗。Objective To explore the risk factors of hydrocephalus and timing of shunt in the patients with traumatic brain injury after decompressive craniectomy.Methods A retrospective analysis was performed on the clinical data of 128 patients with traumatic brain injury who underwent decompressive craniectomy from January 2017 to December 2019.The risk factors of hydrocephalus were analyzed by multivariate logistic regression.Results Of 128 patients,28 patients(21.88%)had hydrocephalus.Multivariate logistic regression analysis showed that subarachnoid hemorrhage,intraventricular hemorrhage,and bone window area≥7 cm2 were independent risk factors for secondary hydrocephalus after decompressive craniectomy in patients with traumatic brain injury(P<0.05).Of 28 patients with hydrocephalus,22 patients underwent ventriculoperitoneal shunt,who were divided into early shunt group and late shunt group according to 3.5 days of median shunt time,with 11 patients each.Compared with the late shunt group,the improvement of intracranial pressure was significantly better and the recovery time of intracranial pressure was significantly shorter in the early shunt group(P<0.05).There was no statistical difference in cerebrospinal fluid indicators and complication rates between both groups(P>0.05).Conclusions Hydrocephalus is a common complication in the patients with traumatic brain injury after decompressive craniectomy.The risk factors of hydrocephalus should be fully evaluated before shunt.Once hydrocephalus occurs,the cause should be identified and the shunt should be performed as early as possible.

关 键 词：颅脑损伤 去骨瓣减压术 脑积水 危险因素 分流时机 

分 类 号：R651.15[医药卫生—外科学] R651.11[医药卫生—临床医学]