【摘要】 目的分析病理情况、诊治方法等诱发重型创伤性脑损伤(traumatic brain injury,TBI)患者发生脑积水的危险因素。方法选取我院2013年1月~2016年1月收治的162例重型TBI患者为研究对象并进行回顾性分析。162例患者均接受为期6个月的随访,将随访期间发生脑积水患者纳入发生组,将未发生脑积水患者纳入未发生组。采用单因素分析和Logistic多元回归分析,比较两组患者一般病理情况、诊治方法等临床资料的差异,总结影响重型TBI患者发生脑积水的危险因素。结果 162例TBI患者中,随访期间共有21例发生脑积水,发生率为12.96%。患者脑积水发生时间为伤后1~9周。单因素分析中两组患者年龄、昏迷时间、蛛网膜下腔出血、大脑凸面硬脑膜下积液、大脑半球间硬脑膜下积液、颅骨缺损、中线偏移、开颅手术情况,差异有统计学意义(P<0.05);多因素回归分析显示,年龄、昏迷时间、中线偏移、开颅手术、单侧颅骨缺损骨瓣下界距颧弓水平距离是导致重型TBI患者发生脑积水的独立危险因素(P<0.05)。结论重型TBI患者发生脑积水的风险较高且与患者病理情况、诊治方法具有密切关联,在保证规范治疗的基础上尽可能纠治患者存在的危险因素,有望降低其伤后脑积水发生率,有助于改善预后。更多还原

【Abstract】 Objective To analyze the risk factors for hydrocephalus in patients with severe traumatic brain injury(TBI)induced by pathological condition and therapeutic method. Methods A retrospective analysis was performed on the clinical data of 162 TBI patients who were admitted to our hospital from January 2013 to January 2016. These patients were followed up for 6 months, and were divided into hydrocephalus group and non-hydrocephalus group according to the diagnostic criteria for hydrocephalus. Univariate analysis and multivariate logistic regression analysis were used to analyze the factors including pathological condition and therapeutic method. Results Totally 21 cases(12.96%) occurred hydrocephalus 1-9 weeks after the injury in 162 patients with TBI. The univariate analysis showed that there were significant differences in age, coma time, subarachnoid hemorrhage, convexity subdural effusion, cerebral hemisphere subdural effusion, skull defect, midline shift and the method of craniotomy operation between the two groups(P<0.05). The multivariate logistic regression analysis indicated the risk factors related to hydrocephalus after traumatic brain injury included: age, coma time, midline shift, craniotomy and unilateral skull bone flap from the lower level of the zygomatic arch distance(P<0.05). Conclusion The risk of hydrocephalus in patients with severe TBI is high, which is closely related to the pathological conditions and the diagnosis and therapeutic method. To reduce the incidence of hydrocephalus after injury, the risk factors existing in TBI patients should be correct on the basis of ensuring the standard treatment.更多还原