重度颅脑损伤并发脑积水危险因素的探讨

目的探讨重度颅脑损伤(STBI)后并发脑积水的危险因素。方法回顾性分析收治的336例颅脑损伤患者的临床资料,对颅脑损伤后并发脑积水的相关因素进行Logistic回归分析。结果 336例重型TBI患者中:65例(19.34%)发生脑积水时间在伤后3周～6个月之间;通过Logistic回归分析发现重度TBI患者发生脑积水主要危险因素:年龄(OR=1.070,P=0.020)、去骨瓣(OR=5.530,P=0.032)、弥散性蛛网膜下腔出血(OR=42.512,P=0.001)、硬脑膜缝合(OR=30.276,P=0.035)、腰椎穿刺放血性脑脊液(OR=2.993,P=0.000)。结论高龄患者、开颅去骨瓣减压术、硬脑膜敞开和弥散性蛛网膜下腔出血是创伤后脑积水发生的主要危险因素,硬膜缝合、腰椎穿刺放血性脑脊液可以降低脑积水的发生率。

Discussion on the risk factors related to hydrocephalus after severe traumatic brain injury

Objective To discuss the risk factors related to hydrocephalus for severe traumatic brain injury（STBI）.Methods Clinical data on 336 cases of severe brain injury were retrospectively analyzed,and logistic regression analysis was used to evaluate the correlation factors.Results Totally 65 cases（19.34%） were found hydrocephalus 3 weeks to six months after injury;the logistic regression analysis indicated the risk factors related to hydrocephalus after severe traumatic brain injury included： age（OR=1.070,P=0.020）,craniectomy（OR=5.530,P=0.032）,diffuse subarachnoid hemorrhage（OR=42.512,P=0.001）,dura mater suture（OR=30.276,P=0.035）,bloody cerebral spinal fluid released by lumbar puncture（OR=2.993,P=0.000）.Conclusion The advanced age,decompressive craniectomy,open dura mater and diffuse subarachnoid hemorrhage are the primary risk factors of the hydrocephalus,and dura mater suture and bloody cerebral spinal fluid released by lumbar puncture can reduce the incidence of hydrocephalus.