创伤性颅脑损伤患者去骨瓣减压术后发生脑积水影响因素分析  

Analysis of influencing factors of hydrocephalus after bone flap decompression in patients with traumatic craniocerebral injury

作　　者：李乾乾 李炜[1] 李林山 LI Qian-qian;LI Wei;LI Lin-shan(Department of Neurosurgery,Baoding first Central Hospital of Hebei Province,Baoding 071000,China)

机构地区：[1]河北省保定市第一中心医院神经重症医学科,河北保定071000 [2]重庆医科大学附属永川医院神经外科,重庆400000

出　　处：《创伤与急危重病医学》2020年第6期438-440,共3页Trauma and Critical Care Medicine

基　　金：重庆市科卫联合医学科研项目(2017JK-S-936)。

摘　　要：目的探讨创伤性颅脑损伤患者去骨瓣减压术后发生脑积水的影响因素。方法选取自2014年6月至2019年1月收治的142例行去骨瓣减压术治疗的创伤性颅脑损伤患者为研究对象,比较发生脑积水与未发生脑积水患者的临床资料,采用多因素Logistic回归分析去骨瓣减压术后发生脑积水的影响因素。结果本组142例创伤性颅脑损伤患者,给予去骨瓣减压术治疗后6个月,发生脑积水患者41例,占28.9%。术后发生脑积水患者的术前格拉斯哥昏迷评分(GCS)、术后1 d的GCS、术后早期进行腰穿的概率均低于未发生脑积水患者,差异有统计学意义(P<0.05)。术后发生脑积水患者的骨瓣面积、术前脑室系统出血概率、术前导水管和环池结构不清晰概率、术后3 d平均颅内压、术后颅内感染发生率均高于未发生脑积水患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,术前GCS评分低、术后1 d GCS评分低、骨瓣面积大、术前脑室系统出血、术前导水管和环池结构不清晰、术后3 d平均颅内压高、术后颅内感染、术后早期未进行腰穿是去骨瓣减压术后发生脑积水的影响因素。结论术前GCS评分低、术后1 d GCS评分低、骨瓣面积大、术前脑室系统出血、术前导水管和环池结构不清晰、术后3 d平均颅内压高、术后颅内感染、术后早期未进行腰穿是颅脑损伤患者去骨瓣减压术后发生脑积水的影响因素,早期识别影响因素并进行干预,可减低患者脑积水的发生率。Objective To investigate the influencing factors of hydrocephalus after bone flap decompression in patients with traumatic craniocerebral injury.Methods A retrospective study was performed on 142 cases of patients with traumatic craniocerebral injury who were admitted and underwent bone flap decompression from June 2014 to January 2019.The clinical data of patients with and without hydrocephalus were compared,and the influencing factors of hydrocephalus after bone flap decompression were analyzed by multivariate Logistic regression.Results In this group,142 patients with traumatic craniocerebral injury were treated with bone flap decompression 6 months after treatment,and 41 patients(28.9%)developed hydrocephalus.The preoperative Glasgow coma Score(GCS),GCS 1 day after surgery,and the probability of lumbar puncture in the early postoperative period of patients with hydrocephalus were all lower than those without hydrocephalus,and the differences were statistically significant(P<0.05).In patients with postoperative hydrocephalus,the bone flap area,the probability of preoperative ventricular hemorrhage,the probability of preoperative aquaqua and ciphal structure unclear,the average intracranial pressure 3 days after the operation,and the incidence of postoperative intracranial infection were all higher than those without hydrocephalus(P<0.05).Multiariable Logistic regression analysis,according to the results of preoperative GCS score low,postoperative 1 day GCS score system,large bone flap area,preoperative ventricle hemorrhage,preoperative aqueduct and ring pool structure is clear,3 d average postoperative intracranial pressure high,postoperative intracranial infection,early postoperative lumbar puncture was to bone disc decompression the influence factors of postoperative hydrocephalus.Conclusion Preoperative GCS score low,postoperative 1 day GCS score system,large bone flap area,preoperative ventricle hemorrhage,preoperative aqueduct and ring pool structure is clear,3 days average high intracranial pressure afte

关 键 词：创伤性颅脑损伤 去骨瓣减压术 脑积水 

分 类 号：R651.1[医药卫生—外科学]