中重型颅脑损伤后脑积水的发生率及相关危险因素分析

发布时间：2018-02-12 14:51

本文关键词： 创伤性颅脑损伤外伤后脑积水危险因素　出处：《福建医科大学》2013年硕士论文　论文类型：学位论文

【摘要】：目的：外伤后脑积水是创伤性颅脑损伤（Traumatic brain injury，TBI）的主要合并症之一，严重地影响患者的生存质量，对社会及个人造成沉重的经济负担。本文主要对TBI后脑积水的形成及其影响因素进行分析以期发现危险因素并加以干预和控制减少外伤后脑积水的发生率。方法：我院2007.09.01~2012.08.31住院治疗的中、重型颅脑外伤患者，对其临床及影像学特征进行分析并统计学上单因素及多因素回归分析。结果： 1.单因素分析发现患者年龄、入院时格拉斯哥昏迷评分（GCS）、去骨瓣减压术、中线移位、是否合并蛛网膜下腔出血与外伤后硬膜下积液有关； 2.多因素回归分析结果提示去骨瓣减压术、中线移位、是否合并蛛网膜下腔出血与硬膜下积液密切相关，而年龄、入院时GCS则无关；去骨瓣减压术的偏回归系数是1.102，OR值3.010，，95%可信区间1.409~4.345；中线移位的偏回归系数是1.072，OR值2.921，95%可信区间1.199~4.241；蛛网膜下腔出血的偏回归系数是1.139，OR值3.124，95%可信区间1.506~4.857。 3.单因素分析发现入院时格拉斯哥昏迷评分、去骨瓣减压术、瞳孔反应、中线移位、是否合并蛛网膜下腔出血、脑室血肿、是否合并硬膜下积液与外伤后脑积水有关； 4.多因素回归分析结果提示入院时GCS、去骨瓣减压术、是否合并蛛网膜下腔出血、脑室血肿、是否合并硬膜下积液与外伤后脑积水密切相关；入院时GCS的偏回归系数是1.399，OR值4.051，95%可信区间2.606~6.297；去骨瓣减压术的偏回归系数是1.744，OR值0.009，95%可信区间3.484~9.387；蛛网膜下腔出血的偏回归系数是3.272，OR值26.364，95%可信区间7.796~65.133；脑室血肿的偏回归系数是1.859，OR值6.417，95%可信区间3.982~10.568；硬膜下积液的偏回归系数是1.560，OR值4.759，95%可信区间3.169~7.611；其中双侧瞳孔无反应组的偏回归系数是1.357，OR值3.884，95%可信区间1.108~6.247。结论： 385例中、重型颅脑外伤患者，硬膜下积液118例，脑积水42例。去骨瓣减压术、中线移位、蛛网膜下腔出血是外伤性硬膜下积液的独立风险因素；入院时格拉斯哥昏迷评分、去骨瓣减压术、脑室血肿、是否合并蛛网膜下腔出血、是否合并硬膜下积液是外伤后脑积水的独立风险因素。针对上述措施进行干预以减少脑积水发生率，改善中重型颅脑损伤患者的预后有重要意义。
[Abstract]:Objective: hydrocephalus after trauma is one of the main complications of traumatic craniocerebral injury (TBI), which seriously affects the quality of life of the patients. This paper analyzes the formation of hydrocephalus after TBI and its influencing factors in order to find out the risk factors and control the incidence of post-traumatic hydrocephalus. Methods: the clinical and imaging features of patients with severe craniocerebral trauma in our hospital were analyzed and analyzed statistically by univariate and multivariate regression analysis. Results:. 1. Univariate analysis showed that age, Glasgow coma score at admission, bone flap decompression, midline displacement, and subarachnoid hemorrhage were associated with subdural effusion after trauma. 2.Multivariate regression analysis showed that decompression, midline displacement and subarachnoid hemorrhage were closely related to subdural effusion, but age, GCS at admission was not. The partial regression coefficient of decompression of bone flap was 1.010 ~ 95% confidence interval 1.409 ~ 4.345, the midline shift partial regression coefficient was 1.072OR 2.92195% confidence interval 1.1994.241, and the partial regression coefficient of subarachnoid hemorrhage was 1.139OR 3.12495% confidence interval 1.5064.857. 3. Univariate analysis showed that Glasgow coma score, decompression of bone flap, pupil reaction, midline displacement, subarachnoid hemorrhage, ventricular hematoma and subdural effusion were associated with post-traumatic hydrocephalus. 4. The results of multivariate regression analysis showed that GCS, decompression of bone flap, subarachnoid hemorrhage, ventricular hematoma and subdural effusion were closely related to post-traumatic hydrocephalus. The partial regression coefficient of GCS on admission was 4.05195% confidence interval 2.6066.297, the partial regression coefficient of bone flap decompression was 1.744U 95% confidence interval 3.48495% confidence interval 3.4849.387, the partial regression coefficient of subarachnoid hemorrhage was 3.272OR 26.36495% confidence interval 7.79665.133; The coefficient of OR was 6.4179.95% confidence interval 3.982n 10.568, the partial regression coefficient of subdural effusion was 1.560U OR 4.75995% confidence interval 3.1697.611, and the partial regression coefficient of bilateral pupillary non-response group was 1.357OR 3.88495% confidence interval 1.1084.247. Conclusion:. Of 385 cases, 118 cases were subdural effusion and 42 cases hydrocephalus. Decompression, midline displacement and subarachnoid hemorrhage were independent risk factors for traumatic subdural effusion. At admission, Glasgow coma score, bone flap decompression, ventricular hematoma, subarachnoid hemorrhage, Whether or not subdural effusion is an independent risk factor for post-traumatic hydrocephalus. It is important to intervene the above measures to reduce the incidence of hydrocephalus and improve the prognosis of patients with moderate and severe craniocerebral injury.
【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R651.15

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