重型颅脑伤患者术后脑积水成因的多因素分析及预防方案

目的：探讨重型颅脑伤(severe traumatic brain injury，STBI)患者术后发生继发性脑积水的相关因素，为临床上如何早期防治继发性脑积水提供指导方案及理论依据。方法：对按同一标准纳入的107例于2010年6月至2013年6月入住宁夏医科大学附属总医院神经外科STBI患者进行前瞻性研究，对年龄、性别、手术前/后格拉斯哥昏迷评分(Glasgow coma scale，GCS)、术后是否继发脑室系统出血、手术前/后颅脑CT中脑导水管及环池结构情况、腰椎穿刺术与继发性脑积水形成之间的关系进行logistic多因素回归分析，探讨术后继发性脑积水的危险因素与保护因素，并着重对保护因素进行分析。结果：多因素回归分析显示：患者术前(OR=0.099，95% CI：0.028~0.350)/术后(OR=0.088，95% CI：0.012~0.649)GCS评分低、术后脑室系统出血(OR=0.168，95% CI：0.029~0.979)、术前(OR=0.134，95% CI：0.038~0.473)/术后(OR=0.221，95% CI：0.055~0.882)颅脑CT中脑导水管及环池结构不清均为STBI术后患者继发性脑积水的危险因素；腰椎穿刺术(OR=75.885，95% CI：9.612~599.122)为STBI术后患者继发性脑积水的保护性因素。且术后脑积水主要发生于术后2周内和2周~3个月，对照组脑积水发生率均明显高于腰椎穿刺组(P<0.05)，术后3个月后2组之间继发性脑积水发生率差异无统计学意义(P>0.05)。 结论：对于STBI术后患者，在生命体征稳定的情况下，早期辅以行腰椎穿刺术可显著降低术后急性期、亚急性期继发性脑积水的发生率，改善患者预后。

Multiplicity and prevention for patients with hydrocephalus secondary to severe traumatic brain injury after surgery

Objective: To investigate the factors for hydrocephalus secondary to severe traumatic brain injuryaft er surgery, and to explore a new theory and guideline for clinical early prevention and treatmentfor hydrocephalus.Methods: The clinical data regarding 107 patients with severe traumatic brain injury, who were admitted to our hospital from June 2010 to June 2013, were analyzed. Logistic multi-factorregression was used to analyze the different factors including ages, gender, the Glasgow comascale (GCS) score before or after surgery, the situation of ventricular system bleeding secondaryto surgery, the situation of midbrain aqueduct and ambient cistern before or after surgery, therelationship between early lumbar puncture and the hydrocephalus. The risk and protective factorsfor postoperative hydrocephalus were discussed.Results: The results showed that patients with low GCS score in pre/postoperative (OR=0.099,95%CI: 0.028–0.350)/(OR=0.088, 95%CI: 0.012–0.649), ventricular system bleeding inpostoperative (OR=0.168, 95%CI: 0.029–0.979) and dim CT image for midbrain aqueduct andambient cistern (OR=0.134, 95%CI: 0.038–0.473)/(OR=0.221, 95%CI: 0.055–0.882) are riskfactors. Whereas lumbar puncture (OR=75.885, 95%CI: 9.612–599.122) is a protective factor forpostoperative hydrocephalus in STBI patients. The secondary hydrocephalus was mainly occurred in2 weeks and 2 weeks to 3 months after operation. The incidence of the control group that occurredsecondary hydrocephalus is higher than that of the lumbar puncture group (P<0.05). The secondaryhydrocephalus were mainly occurred in 2 weeks and 2 weeks to 3 months after operation, with nostatistical significance between the 2 groups after 3 months of operation (P>0.05).Conclusion: For patients with stable vital signs, early lumbar puncture could significantly reducethe incidence of secondary hydrocephalus in acute and subacute stage after severe traumatic braininjury.