【摘要】 目的探究重型颅脑损伤术后继发外伤性脑积水的相关危险因素及处理对策。方法 128例重型颅脑损伤术后患者为研究对象,根据有无继发外伤性脑积水分为继发外伤性脑积水组(41例)与无脑积水组(87例)。通过本院自制的问卷调查法对患者的相关信息进行搜集,分析重型颅脑损伤术后继发外伤性脑积水的危险因素,危险因素与重型颅脑损伤术后继发外伤性脑积水的相关性。结果继发外伤性脑积水组患者年龄≥60岁占比为73.17%(30/41)、术后颅内压>25 mm Hg(1 mm Hg=0.133 kPa)占比为60.98%(25/41)、颅内感染占比为60.98%(25/41)、蛛网膜下腔出血占比为58.54%(24/41),均高于无脑积水组的40.23%(35/87)、34.48%(30/87)、36.78%(32/87)、33.33%(29/87),差异具有统计学意义(P<0.05)。两组患者的性别、致伤原因、入院时格拉斯哥昏迷指数(GCS)评分、颅内血肿位置、手术时间比较,差异无统计学意义(P>0.05)。Logistic回归分析显示,年龄≥60岁[OR=12.936, 95%CI=(3.913, 42.759)]、术后颅内压>25 mm Hg[OR=11.822, 95%CI=(3.057, 45.713)、颅内感染[OR=14.013,95%CI=(4.585, 42.828)、蛛网膜下腔出血[OR=5.989, 95%CI=(1.742, 20.589)是重型颅脑损伤术后继发外伤性脑积水的独立危险因素。年龄、术后颅内压、颅内感染、蛛网膜下腔出血与重型颅脑损伤术后继发外伤性脑积水呈正相关性(r=0.845、0.795、0.817、0.786, P=0.000、0.000、0.000、0.000<0.05)。结论年龄、术后颅内压>25 mm Hg、颅内感染以及蛛网膜下腔出血是重型颅脑损伤术后患者继发外伤性脑积水的独立危险因素,可作为切入点对重型颅脑损伤术后预防外伤性脑积水实施干预措施。更多还原

【Abstract】 Objective To investigate the related risk factors and treatment countermeasures of secondary traumatic hydrocephalus after severe craniocerebral injury. Methods A total of 128 patients after servere craniocerebral injury as study subjects were divided into secondary traumatic hydrocephalus group(41 cases) and non-hydrocephalus group(87 cases) according to the presence or absence of secondary traumatic hydrocephalus. The relevant information of patients was collected by the self-made questionnaire survey of our hospital. Analysis was made on the risk factors of secondary traumatic hydrocephalus after severe craniocerebral injury, and correlation between risk factors and secondary traumatic hydrocephalus after severe craniocerebral injury. Results The proportion of age≥60 years old, postoperative intracranial pressure>25 mm Hg(1 mm Hg= 0.133 kPa), intracranial infection and subarachnoid hemorrhage of secondary traumatic hydrocephalus group were 73.17%(30/41), 60.98%(25/41), 60.98%(25/41) and 58.54%(24/41), which were higher than 40.23%(35/87), 34.48%(30/87), 36.78%(32/87) and 33.33%(29/87) of non-hydrocephalus group, and the difference was statistically significant(P<0.05). There was no statistically significant difference in gender, cause of injury, Glasgow coma index(GCS) score on admission, location of intracranial hematoma and operation time between the two groups(P>0.05). Logistic regression analysis showed that age≥60 years old [OR=12.936, 95%CI=(3.913, 42.759)], postoperative intracranial pressure >25 mm Hg [OR=11.822, 95%CI=(3.057, 45.713)], intracranial infection [OR=14.013, 95%CI=(4.585, 42.828)] and subarachnoid hemorrhage [OR=5.989, 95%CI=(1.742, 20.589)] were independent risk factors of secondary traumatic hydrocephalus after severe craniocerebral injury. Age, postoperative intracranial pressure, intracranial infection, subarachnoid hemorrhage were positively correlated with secondary traumatic hydrocephalus after severe craniocerebral injury(r=0.845, 0.795, 0.817, 0.786; P=0.000, 0.000, 0.000, 0.000<0.05). Conclusion Age, postoperative intracranial pressure >25 mm Hg, intracranial infection and subarachnoid hemorrhage were independent risk factors of secondary traumatic hydrocephalus after severe craniocerebral injury, which can be used as intervention measures to prevent traumatic hydrocephalus after severe craniocerebral injury.更多还原