脑室外引流后穿刺道出血的危险因素分析

目的探讨脑室外引流后穿刺道出血的危险因素，为预防和早期诊治脑室外引流后穿刺道出血提供理论依据。 方法回顾性分析阜阳市肿瘤医院神经外科自2018年1月至2021年5月收治的脑室外引流手术患者114例，根据其有无穿刺道出血分为出血组（28例）及未出血组（86例）。比较2组患者的基线资料，并将单因素分析中有统计学意义的因素纳入多因素Logistic回归分析，探究脑室外引流后穿刺道出血的独立危险因素。 结果单因素分析结果显示，出血组患者年龄、脑卒中史、术前抗血小板药物、术前抗凝药物穿刺次数高于未出血组，同期颅脑手术率低于未出血组，差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，术前抗血小板药物（OR=7.205，95%CI：2.243~23.144）、穿刺次数（OR=2.473，95%CI：1.315~4.650）是脑室外引流后穿刺道出血的独立危险因素，而同期颅脑手术（OR=0.163，95%CI：0.038~0.702）是脑室外引流后穿刺道出血的独立保护因素。 结论术前抗血小板药物和穿刺次数是脑室外引流后穿刺道出血的独立危险因素，同期颅脑手术是脑室外引流后穿刺道出血的独立保护因素，临床中应注意积极预防、早期干预。

Risk factors of hemorrhage associated with external ventricular drainage

ObjectiveTo investigate the risk factors of hemorrhage associated with external ventricular drainage (EVD), and to provide theoretical basis for the prevention and early diagnosis and treatment of hemorrhage associated with EVD. MethodsA retrospective analysis was made of 114 patients with extraventricular drainage surgery admitted to Neurosurgery Department of Fuyang Cancer Hospital from January 2018 to May 2021. They were divided into bleeding group (28 cases) and non bleeding group (86 cases) according to whether they had hemorrhage associated with EVD. The baseline data of the two groups were compared, and then the factors with statistical significance in univariate analysis were included in multivariate Logistic regression analysis to explore the independent risk factors of hemorrhage associated with EVD. ResultsThe results of univariate analysis showed that the age, previous stroke rate, preoperative antiplatelet drug use rate, preoperative anticoagulant drug use rate and puncture times of patients in the bleeding group were higher than those in the non bleeding group, and the concurrent brain surgery rate was lower than in the non bleeding group, with significant differences (P<0.05). The results of multivariate Logistic regression analysis showed that the use of preoperative antiplatelet drugs (OR=7.205, 95%CI:2.243-23.144) was a protective factor, while the number of punctures (OR=2.473, 95%CI: 1.315-4.650) and concurrent craniocerebral surgery (OR=0.163, 95%CI: 0.038-0.702) was a possible independent protective factor for puncture tract hemorrhage after extraventricular drainage (P<0.05). ConclusionPreoperative use of antiplatelet drugs is a protective factor, while the number of puncture times and simultaneous craniocerebral surgery may be independent risk factors for puncture hemorrhage after extraventricular drainage, so attention should be paid to active prevention and early intervention in clinical practice.