重型颅脑创伤患者开颅术中急性脑膨出的危险因素分析  

Risk factors of acute encephalocele during craniotomy in patients with severe craniocerebral trauma

作　　者：方舒 蒋建英 徐龙彪 FANG Shu;JIANG Jianying;XU Longbiao(Operating Room,Zhuji People′s Hospital in Zhejiang Province,Zhuji311800,China)

机构地区：[1]浙江省诸暨市人民医院手术室,浙江诸暨311800

出　　处：《中国现代医生》2022年第10期115-118,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2020PY081)。

摘　　要：目的 探讨重型颅脑创伤患者开颅术中急性脑膨出的发生率及其危险因素。方法 选取2019年1月至2020年12月浙江省诸暨市人民医院收治的203例进行开颅手术的重型颅脑创伤患者,依据其术中是否发生急性脑膨出将其分为脑膨出组(n=74)和无脑膨出组(n=129);比较两组间的别、年龄、创伤原因、高血压、糖尿病、术前凝血异常、入院GCS评分、手术远端部位骨折、术前低血压、术前缺氧、术前颅内压、脑脊液漏、脑干损伤、蛛网膜下腔出血、弥漫性脑肿胀、术前脑疝、迟发性颅内血肿、脑积水等因素的差异性;再使用逐步logistic回归法筛选影响术中急性脑膨出的相关危险因素。结果 203例重型颅脑创伤患者开颅术中急性脑膨出发生率36.45%(74/203);影响术中急性脑膨出的危险因素有术前凝血异常(OR=2.852)、入院GCS评分(OR=3.842)、手术远端部位骨折(OR=4.446)、术前颅内压(OR=3.117)、弥漫性脑肿胀(OR=4.614)、术前脑疝(OR=3.497)、迟发性颅内血肿(OR=5.366)等。结论 急性脑膨出是重型颅脑创伤患者开颅术中的重要并发症,应根据其发病机制和高危因素,早期进行干预和治疗,降低术中急性脑膨出的发生率。Objective To investigate the incidence and risk factors of acute encephalocele in patients with severe craniocerebral trauma during craniotomy. Methods A total of 203 patients with severe craniocerebral trauma undergoing craniotomy in Zhuji People′s Hospital in Zhejiang from January 2019 to December 2020 were selected and divided into the encephalocele group(n=74) and the non-encephalocele group(n=129) according to whether acute encephalocele occurred during the operation. The differences between the two groups in gender,age,trauma causes, hypertension, diabetes, preoperative coagulation abnormalities,GCS scores on admission, fractures at the distal part of the operation, preoperative hypotension, preoperative hypoxia, preoperative intracranial pressure, cerebrospinal fluid leakage, brain stem injury,subarachnoid hemorrhage, diffuse brain swelling, preoperative cerebral hernia,delayed intracranial hematoma, hydrocephalus and other factors were compared. Then, stepwise logistic regression was used to screen the related risk factors of acute encephalocele during operation. Results The incidence of acute encephalocele of 203 patients with severe craniocerebral trauma during craniotomy was 36.45%(74/203). Risk factors affecting intraoperative acute encephalocele included preoperative coagulation abnormality(OR=2.852), GCS score on admission(OR=3.842), fracture at the distal part of the operation(OR=4.446), preoperative intracranial pressure(OR=3.117), diffuse brain swelling(OR=4.614),preoperative cerebral hernia(OR=3.497) and delayed intracranial hematoma(OR=5.366). Conclusion Acute encephalocele is an important complication during craniotomy for patients with severe craniocerebral trauma. Early intervention and treatment should be carried out according to its pathogenesis and high risk factors to reduce the incidence of acute encephalocele during operation.

关 键 词：颅脑创伤 开颅手术 脑膨出 危险因素 

分 类 号：R651.1[医药卫生—外科学]