重型颅脑损伤后并发脑积水的多因素分析

目的探讨重型颅脑创伤后并发脑积水的危险因素。方法回顾性分析2009年1月~2014年5月收治的248例重型颅脑损伤患者的临床资料,其中男性180例,女性68例;年龄18~74岁,平均51.2岁。致伤原因:道路交通伤200例,高处坠落伤23例,殴打伤8例,硬物砸伤10例,其他伤7例。根据伤后是否并发脑积水分为脑积水组(50例)和无脑积水组(198例)。对颅脑损伤后并发脑积水的相关因素,如患者的年龄、入院时格拉斯哥昏迷评分(GCS)、去骨瓣、硬脑膜有无缝合、蛛网膜下腔出血(SAH)情况、血肿位置及腰椎穿刺有无引流脑脊液等,进行Logistic回归分析。结果 248例颅脑损伤患者中,50例(20.2%)发生脑积水;通过Logistic回归分析发现重型颅脑损伤患者发生脑积水主要危险因素为年龄(OR=1.823,P=0.031)、去骨瓣(OR=1.136,P=0.000)、弥散性SAH(OR=2.288,P=0.018)、硬脑膜缝合(OR=1.711,P=0.037)、腰椎穿刺放血性脑脊液(OR=0.449,P=0.002)。结论高龄患者、去骨瓣减压、硬脑膜开放以及弥散性SAH是重型颅脑损伤后并发脑积水的危险因素,采取硬脑膜缝合、腰椎穿刺引流血性脑脊液可降低脑积水的发生率。

Analysis of multiple factors related to hydrocephalus after traumatic brain injury

Objective To discuss the risk factors related to hydrocephalus for traumatic brain injury. Methods The clinical data of 248 patients with severe craniocerebral injury were retrospectively analyzed from Jan.2009 to May 2014,including 180 males and 68 females aged from 18-74 years with an average age of 51.2 years.The causes of injury included traffic accidents (200 cases),falling (23 cases),beating (8 cases),smashed by a hard object (10 cases),and other types of injury(7 cases).In all the 248 cases,50 patients suffered from hy-drocephalus,and the other 198 did not.Moreover,the logistic regression analysis was used to evaluate the correla-tive factors leading to hydrocephalus,such as age,Glasgow Coma Scale ( GCS) on admission,removal of skull flap, dural suture,subarachnoid hemorrhage (SHA),hematoma location and drainage of cerebrospinal fluid (CSF) by lumbar puncture.Results Hydrocephalus was found in 50 cases(20.2%) after injury;the logistic regression a-nalysis indicated the following risk factors related to hydrocephalus after traumatic brain injury:age( OR=1.823, P=0.031),craniectomy(OR=1.136,P=0.000),diffuse subarachnoid hemorrhage(OR=2.288,P=0.018),du-ra mater suture (OR=1.711,P=0.037) and bloody cerebral spinal fluid released by lumbar puncture(OR =0.449,P=0.002).Conclusion The advanced age,decompressive craniectomy,open dura mater and diffuse sub-arachnoid hemorrhage are the primary risk factors of the hydrocephalus.Dura mater suture and drainage of bloody CSF by lumbar puncture can reduce the incidence of hydrocephalus.