脑积水腰大池⁃腹腔分流术预后影响因素分析  

Analysis of factors affecting the efficacy of lumboperitoneal shunt in the treatment of hydrocephalus

作　　者：赵浩 曲鑫 王宁[1] 尚峰 徐跃峤[1] 齐猛[1] ZHAO Hao;QU Xin;WANG Ning;SHANG Feng;XU Yue-qiao;QI Meng(Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院神经外科,北京100053

出　　处：《中国现代神经疾病杂志》2024年第6期450-454,共5页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：首都医科大学校培育(自然类)立项项目(项目编号:PYZ21037)。

摘　　要：目的筛查脑积水患者腰大池⁃腹腔分流术后短期神经功能预后的影响因素。方法纳入2014年10月至2020年1月在首都医科大学宣武医院行腰大池⁃腹腔分流术的136例脑积水患者,出院时采用改良Rankin量表(mRS)评价脑积水术后短期神经功能预后,单因素和多因素Logistic回归分析筛查术后短期神经功能预后不良的影响因素。结果共136例患者根据出院时mRS评分分为预后良好(mRS评分≤3分)组(65例)和预后不良(mRS评分>3分)组(71例),Logistic回归分析,入院时Glasgow昏迷量表(GCS)评分9~12分(OR=7.800,95%CI:7.205~8.443;P=0.000)和3~8分(OR=6.299,95%CI:5.744~6.907;P=0.006),病因为颅脑创伤(OR=27.681,95%CI:24.270~31.572;P=0.000)、脑出血(OR=13.017,95%CI:11.473~14.769;P=0.005)、蛛网膜下腔出血(OR=17.682,95%CI:15.683~19.935;P=0.001)和其他原因(OR=5.851,95%CI:5.166~6.628;P=0.050)是脑积水患者腰大池⁃腹腔分流术后短期神经功能预后不良的危险因素。结论脑积水患者腰大池⁃腹腔分流术后神经功能预后受多种因素影响,不同入院时GCS评分、不同病因患者预后不同,应根据具体情况制定个性化治疗方案。Objective To screen factors influencing the neurological prognosis following lumboperitoneal shunt(LPS)in patients with hydrocephalus.Methods Total 136 patients who underwent LPS in Xuanwu Hospital,Capital Medical University from October 2014 to January 2020.The short⁃term neurological prognosis post⁃surgery were evaluated by modified Rankin Scale(mRS)at discharge.Univariate and multivariate stepwise Logistic regression analyses were conducted to screen factors affecting neurological prognosis.Results Of the 136 patients,65 were categorized into the good prognosis group(mRS score≤3),and 71 into the poor prognosis group(mRS score>3).Logistic regression analysis indicated that an admission Glasgow Coma Scale(GCS)score of 9-12(OR=7.800,95%CI:7.205-8.443;P=0.000)and 3-8(OR=6.299,95%CI:5.744-6.907;P=0.006),as well as etiologies including traumatic brain injury(OR=27.681,95%CI:24.270-31.572;P=0.000),cerebral hemorrhage(OR=13.017,95%CI:11.473-14.769;P=0.005),subarachnoid hemorrhage(OR=17.682,95%CI:15.683-19.935;P=0.001),and other causes(OR=5.851,95%CI:5.166-6.628;P=0.050)were risk factors for poor short⁃term neurological prognosis in patients with hydrocephalus undergoing LPS.Conclusions The neurological prognosis after LPS in patients with hydrocephalus is influenced by multiple factors.Prognoses vary among patients with different admission GCS scores and different etiologies.Personalized treatment plans should be developed based on specific circumstances.

关 键 词：脑积水 脑脊髓液分流术 预后 危险因素 LOGISTIC模型 

分 类 号：R651.1[医药卫生—外科学]