脑室-腹腔分流术相关迟发性脑出血的危险因素分析  

Analysis of risk factors of delayed intracerebral hemorrhage related to ventriculo-peritoneal shunt

作　　者：孟凡东 郭玉龙 李永飞 王斌 马媛媛 王玉社 Meng Fandong;Guo Yulong;Li Yongfei;Wang Bin;Ma Yuanyuan;Wang Yushe(Department of Neurosurgery,Henan Provincial People′s Hospital(Zhengzhou University People′s Hospital,Henan University People′s Hospital),Zhengzhou 450003,China;Department of Anesthesiology and Perioperative Care,Henan Provincial People's Hospital(Zhengzhou University People's Hospital,Henan University People's Hospital),Zhengzhou 450003,China)

机构地区：[1]河南省人民医院(郑州大学人民医院,河南大学人民医院)神经外科,郑州450003 [2]河南省人民医院(郑州大学人民医院, 河南大学人民医院)麻醉与围手术期医学科, 郑州450003

出　　处：《中华神经外科杂志》2025年第1期63-67,共5页Chinese Journal of Neurosurgery

基　　金：河南省医学科技攻关计划(SB201902027)。

摘　　要：目的探讨脑室-腹腔分流术(VPS)相关迟发性脑出血(DICH)的危险因素。方法回顾性分析2022年1月至2023年3月河南省人民医院神经外科行VPS治疗的315例脑积水患者的临床资料。根据术后是否发生DICH分为未出血组(271例)和出血组(44例)。采用单因素分析和多因素logistic回归模型(输入法)分析法明确发生DICH的重要影响因素。结果出血组较未出血组男性[75.00%(33/44)对比51.66%(140/271)]、有吸烟史[36.36%(16/44)对比21.40%(58/271)]、饮酒史[36.36%(16/44)对比18.82%(51/271)]、分流管周围脑水肿[70.45%(31/44)对比32.47%(88/271)]及术后剧烈咳嗽[29.55%(13/44)对比6.27%(17/271)]的患者占比均高,收缩压极差[M(Q 1,Q 3)][51(37,65)mmHg(1 mmHg=0.133 kPa)对比41(31,51)mmHg]大(均P<0.05)。多因素logistic回归模型分析显示,分流管周围脑水肿(OR=6.07,95%CI:2.72~13.57,P<0.001)、收缩压极差增加(OR=1.03,95%CI:1.01~1.05,P=0.014)、术后剧烈咳嗽(OR=6.67,95%CI:2.35~18.90,P<0.001)均为VPS相关DICH的独立危险因素。结论VPS后存在分流管周围脑水肿、收缩压大幅波动、剧烈咳嗽的患者发生DICH的风险较高。Objective To analyze the risk factors of delayed intracerebral hemorrhage(DICH)after ventriculo-peritoneal shunt(VPS).Methods Clinical data of 315 patients with hydrocephalus who underwent VPS treatment in the Neurosurgery Department of Henan Provincial People′s Hospital from January 2022 to March 2023 were retrospectively analyzed.They were divided into non-DICH group(271 cases)and DICH group(44 cases)according to whether DICH occurred after surgery.The important influencing factors for the occurrence of DICH were identified using univariate analysis and multivariate logistic regression analysis(input method).Results There was a higher proportion of male patients in the DICH group than in the non-DICH group[75.00%(33/44)vs.51.66%(140/271)],a higher proportion of patients with a history of smoking[36.36%(16/44)vs.21.40%(58/271)],alcohol consumption[36.36%(16/44)vs.18.82%(51/271)],cerebral oedema around catheter[70.45%(31/44)vs.32.47%(88/271)]and postoperative severe cough[29.55%(13/44)vs.6.27%(17/271)],and a greater range of systolic blood pressure[M(Q 1,Q 3)][51(37,65)mmHg(1 mmHg=0.133 kPa)vs.41(31,55)mmHg](all P<0.05).Multivariate logistic regression analysis showed that cerebral oedema around catheter(OR=6.07,95%CI:2.72-13.57,P<0.001),increased range of systolic blood pressure(OR=1.03,95%CI:1.01-1.05,P=0.014),postoperative severe cough(OR=6.67,95%CI:2.35-18.90,P<0.001)were all independent risk factors for the occurrence of DICH after VPS.Conclusion Patients with cerebral oedema around catheter,great fluctuations in systolic blood pressure and severe coughing after VPS have a higher risk of DICH.

关 键 词：脑脊髓液分流术 影响因素分析 迟发性脑出血 

分 类 号：R651.12[医药卫生—外科学]