【摘要】 目的研究脑外伤术中急性脑膨出的危险因素及手术策略。方法回顾性分析626例接受脑外伤手术患者临床病理资料,记录术中脑膨出发生率,根据术中是否发生急性脑膨出分为观察组（发生急性脑膨出,72例）和对照组（未发生急性脑膨出,554例）。比较两组患者性别、年龄、BMI、疾病类型、致伤原因、受伤至手术时间、术前格拉斯哥昏迷评分（GCS）、颅内压及缺氧状态、合并症、中线移位距离等基本资料和临床特征。采用Logistic多因素分析术中脑膨出的危险因素,建立危险因素对术中发生急性脑膨出的风险预测模型。结果受伤至手术时间是脑外伤术中急性脑膨出的保护因素,手术远隔部位骨折、术前颅内压、术前缺氧及合并迟发性颅内血肿（DTIH）或外伤性急性弥漫性脑肿胀（PADBS）是术中发生急性脑膨出的独立危险因素（P<0.05）。急性脑膨出的预后指数（PI）为0.764X₁+1.089X₂+1.225X₃+0.953X₄+1.426X₅+0.857X₆（X₁=受伤至手术时间,X₂=手术远隔部位骨折,X₃=术前颅内压,X₄=术前缺氧,X₅=DTIH,X₆=PADBS）。当PI≥1.679时,术中发生急性脑膨出的风险显著增加。结论受伤至手术时间、手术远隔部位骨折、颅内高压、术前缺氧及合并DTIH和PADBS是术中急性脑膨出的独立影响因素,针对危险因素进行术前和术中干预有助于降低急性脑膨出风险。更多还原

【Abstract】 Objective To study the risk factors and operation strategy of acute encephalocele in the operation of brain injury. Methods The clinical and pathological datas of 626 patients who underwent brain trauma surgery were analyzed retrospectively. The incidence of encephalocele during operation was recorded. According to whether acute brain swelling occurred during surgery,it was divided into observation group（ 72 cases with acute encephalocele） and control group（ 554 cases without acute encephalocele）. The basic data such as sex,age,BMI,disease type,cause of injury,injury to operation time,preoperative Glasgow coma scale（ GCS）,intracranial pressure and hypoxia,complications,median displacement distance and clinical features were compared between the two groups. The risk factors of encephalocele were analyzed by Logistic multifactor analysis,the risk prediction model for the risk of acute encephalocele during the operation was established. Results The time from injury to operation was a protective factor for acute encephalocele during operation. The operation site distant fracture,preoperative intracranial pressure,preoperative anoxia and DTIH or PADBS were independent risk factors for intraoperative acute encephalocele（ P < 0. 05）. The prognostic index of acute encephalocele was 0. 764X₁+ 1. 089X₂+ 1. 225X₃+ 0. 953X₄+ 1. 426X₅+ 0. 857X₆（ X₁= the time of injury to operation,X₂= the operation site distant fracture,X₃= preoperative intracranial pressure,X₄= preoperative anoxia,X₅= DTIH,X₆= PADBS）. The risk of acute encephalocele during surgery was significantly increased when PI≥1. 679. Conclusion The time of injury to operation,distant site fracture,intracranial hypertension,preoperative anoxia and DTIH and PADBS are independent factors of intraoperative acute encephalocele. The preoperative and intraoperative interventions for risk factors can help to reduce the risk of acute encephalocele.更多还原