重度颅脑损伤术后并发脑疝的危险因素分析及预警性干预建议  

Risk factors and early-warning intervention recommendations for postoperative cerebral hernia after severe craniocerebral injury

作　　者：孙静[1] 吕璇 杨静平 丁丁[1] SUN Jing;LU Xuan;YANG Jingping;DING Ding(Department of Neurosurgery,Suzhou Hospital of Anhui Medical University,Suzhou,Anhui 234000,China)

机构地区：[1]安徽医科大学附属宿州医院神经外科,安徽宿州234000

出　　处：《国际神经病学神经外科学杂志》2023年第4期25-28,共4页Journal of International Neurology and Neurosurgery

摘　　要：目的分析重度颅脑损伤术后并发脑疝的危险因素。方法对安徽医科大学附属宿州医院2018年6月—2021年6月收治的120例重度颅脑损伤患者的临床资料进行回顾性分析,并统计脑疝发生率和死亡率,分析并发脑疝的危险因素。结果术后并发脑疝33例,脑疝发生率27.50%,且并发组和未并发组死亡率分别为27.27%和11.49%,差异有统计学意义(χ^(2)=4.470,P=0.035);多因素Logistic回归分析结果显示,年龄>60岁、吸烟史、术前GCS≤6分、合并心房颤动、合并低钠血症、术前基底池受压、术后甘露醇半量、腰椎穿刺、术后并发颅内血肿为并发脑疝的危险因素(均P<0.05)。结论重度颅脑损伤患者术后并发脑疝风险较高,危险因素较多,需要加强预警,及时进行干预。Objective To investigate the risk factors for postoperative cerebral hernia after severe craniocerebral injury.Methods A retrospective analysis was performed for the clinical data of 120 patients with severe craniocerebral injury who were admitted in Suzhou Hospital of Anhui Medical University from June 2018 to June 2021.A statistical analysis was performed for the incidence and mortality rates of brain herniation,and the risk factors for brain herniation were summarized.Results Of all patients,33 experienced brain herniation after surgery,and the incidence rate of brain herniation was 27.50%.There was a significant difference in mortality rate between the complicated group and the non-complicated group(27.27%vs 11.49%,χ^(2)=4.470,P=0.035).The multivariate logistic regression analysis showed that age>60 years,smoking history,preoperative GCS score≤6 points,atrial fibrillation,hyponatremia,preoperative basal cistern compression,half dose of mannitol after surgery,lumbar puncture,and postoperative intracranial hematoma were independent risk factors for brain herniation(odds ratio=7.382,6.666,6.360,5.912,5.087,6.032,5.228,5.119,and 5.053,P<0.05).Conclusions Patients with severe craniocerebral injury tend to have a high risk of brain herniation and a large number of risk factors,and it is necessary to strengthen early warning and give timely intervention.

关 键 词：重度颅脑损伤 脑疝 危险因素 预警性干预 

分 类 号：R512.91[医药卫生—内科学]