重型及特重型颅脑损伤患者继发性脑积水发生的影响因素分析  

Analysis of factors affecting the occurrence of secondary hydrocephalus in patients with severe and very severe craniocerebral injury

作　　者：张绪明[1] 孙成法[1] 褚荣涛[1] ZHANG Xu-ming;SUN Cheng-fa;CHU Rong-tao(Department of Neurosurgery,Changshu Second People's Hospital,Jiangsu Province,Changshu 215500,China)

机构地区：[1]江苏省常熟市第二人民医院神经外科,江苏常熟215500

出　　处：《中国当代医药》2020年第35期90-93,共4页China Modern Medicine

摘　　要：目的分析重型及特重型颅脑损伤患者继发性脑积水发生的影响因素。方法选取2015年1月~2020年2月常熟市第二人民医院收治的63例重型和特重型颅脑损伤患者,根据患者受伤严重程度将其分为重型组(34例)和特重型组(29例)。记录患者的临床资料和并发继发性脑积水情况,采用多因素回归分析重型和特重型颅脑损伤患者继发性脑积水发生的影响因素。结果两组患者的性别、年龄、致伤原因比较,差异无统计学意义(P>0.05)。继发性脑积水患者共19例(30.16%),重型组中继发性脑积水6例(17.65%),特重型组中继发性脑积水13例(44.83%)。单因素分析结果显示,年龄、受伤程度、格拉斯哥昏迷评分量表(GCS)评分、行去骨瓣减压术治疗、血肿位置、颅内感染、脑室内积血是重型及特重型颅脑损伤患者继发性脑积水发生的影响因素(P<0.05)。多因素分析结果显示,年龄(β=0.841,OR=2.854,95%CI:2.741~4.901)、GCS评分(β=2.687,OR=6.541,95%CI:3.957~7.537)、血肿位置(β=0.677,OR=1.147,95%CI:1.014~3.284)、脑室内积血(β=1.035,OR=2.254,95%CI:1.954~5.257)是重型及特重型颅脑损伤患者继发性脑积水发生的独立影响因素(P<0.05)。结论年龄较大、GCS评分低、硬膜下及脑内血肿、脑室内积血的重型及特重型颅脑损伤患者易发生继发性脑积水,应当采取合理措施干预危险因素,降低继发性脑积水发生率。Objective To analyze the factors affecting the occurrence of secondary hydrocephalus in patients with severe and very severe craniocerebral injury.Methods A total of 63 patients with severe and very severe craniocerebral injury admitted to Changshu Second People's Hospital from January 2015 to February 2020 were selected,and the patients were divided into severe group(34 cases)and very severe group(29 cases)according to the severity of the injury.The clinical data of the patients and the condition of secondary hydrocephalus were recorded,and the multivariate regression analysis was used to analyze the influencing factors of secondary hydrocephalus in patients with severe and very severe craniocerebral injury.Results There were no significant differences in gender,age and cause of injury between the two groups(P>0.05).There were 19 cases(30.16%)with secondary hydrocephalus,6 cases(17.65%)with secondary hydrocephalus in the severe group and 13 cases(44.83%)with secondary hydrocephalus in the very severe group.Univariate analysis results showed that age,degree of injury,Glasgow coma scale(GCS)score,decompressive craniectomy treatment,location of hematoma,intracranial infection and intracerebral hematoma were the influencing factors for secondary hydrocephalus in patients with severe and very severe craniocerebral injury(P<0.05).Multivariate analysis showed that age(β=0.841,OR=2.854,95%CI:2.741-4.901),GCS score(β=2.687,OR=6.541,95%CI:3.957-7.537),location of hematoma(β=0.677,OR=1.147,95%CI:1.014-3.284)and intraventricular hemorrhage(β=1.035,OR=2.254,95%CI:1.954-5.257)were independent influencing factor for the occurrence of secondary hydrocephalus in patients with severe and very severe craniocerebral injury(P<0.05).Conclusion Severe and very severe craniocerebral injury patients with old age,low GCS score,subdural and intracerebral hematoma,intraventricular hemorrhage are prone to secondary hydrocephalus,and reasonable measures should be taken to intervene risk factors to reduce the incidence of secondary hydroc

关 键 词：重型颅脑损伤 特重型颅脑损伤 继发性脑积水 危险因素 

分 类 号：R651[医药卫生—外科学]