重型颅脑损伤患者大骨瓣减压术后脑膨出影响因素的临床分析

发布时间：2018-07-10 00:05

本文选题：重型颅脑损伤 + 去大骨瓣减压　；参考：《郑州大学》2017年硕士论文

【摘要】：目的探讨重型颅脑损伤去大骨瓣减压术(Large Decompressive Craniectomy,LDC)术后并发脑膨出的危险因素及其对患者预后的影响,提高对重型颅脑损伤(sTBI)患者去骨瓣减压术后并发脑膨出的认识,为预防和减少术后脑膨出的发生提供依据,从而提高重型颅脑损伤患者预后。方法回顾性分析我院神经外科收治的265例行去大骨瓣减压术患者的临床资料,181例发生术后脑膨出,对其相关临床因素:术前GCS、基底池消失、中线移位1cm、术中人工硬膜减张缝合、术后迟发型脑出血、术后颅内感染、术后脑积水对比分析,术后脑膨出对半年患者预后GOS评分的影响。结果1、265例患者术后发生脑膨出者181例,发生率约为68.30%(181/265)。年龄膨出组(42.90±16.22)、未膨出组(43.73±16.68),P=0.706,差异无统计学意义。性别膨出组男140(77.35%)、未膨出组63(75.00%),P=0.674差异无统计学意义。单因素分组卡方检验患者术前GCS评分、中线移位1cm、基底池消失、迟发型颅内出血、未行人工硬膜减张缝合缺损硬膜、迟发性创伤性颅内血肿(DTICH)、术后感染为术后脑膨出的危险因素(P0.05)。2、两组患者的6个月后GOS评分对比显示:膨出组患者预后差于非膨出组(P0.05)。3、将有意义的单因素进行多因素logistic回归分析显示:GCS评分(OR=1.837,95%CI为1.021-3.304,P=0.042)、未行人工硬膜减张缝合(OR=1.892%,95%CI为1.072-3.340,P=0.028)、迟发型出血(OR=2.147%CI为1.130-4.079,P=0.020)是术后脑膨出发生的独立危险因素。结论1、重型颅脑损伤患者术前GCS评分低、术中未行人工硬膜减张缝合、术后迟发型出血增加术后脑膨出的发生。2、重型颅脑损伤患者术后出现脑膨出半年预后较未出现脑膨出者差。
[Abstract]:Objective to investigate the risk factors of severe craniocerebral injury complicated with encephalocele after large Decomponsive decompression of craniectomy and its influence on the prognosis of patients with severe craniocerebral injury (sTBI), and to improve the understanding of patients with severe craniocerebral injury (sTBI) after decompression of craniectomy. To prevent and reduce the occurrence of postoperative encephalocele, so as to improve the prognosis of patients with severe craniocerebral injury. Methods the clinical data of 265 cases of decompression of large bone flap in our hospital were retrospectively analyzed. The clinical factors related to the occurrence of postoperative encephalocele were as follows: preoperative GCSs, disappearance of basal cistern, midline displacement of 1 cm, artificial epidural tension-reduction suture during operation. Postoperative delayed intracerebral hemorrhage, postoperative intracranial infection, postoperative hydrocephalus, postoperative encephalocele on the prognosis of patients with GOS score. Results there were 181 cases of encephalocele after operation in 1265 cases, the incidence was about 68.30% (181 / 265). The age group (42.90 卤16.22) was not significantly different from the control group (43.73 卤16.68). There was no significant difference between male (77.35%) and uninflated group (63 (75.00%). Patients with univariate chi-square test had preoperative GCS score, midline shift of 1 cm, disappearance of basal cistern, delayed intracranial hemorrhage, and no artificial dural detension-suture. Delayed traumatic intracranial hematoma (DTICH) and postoperative infection were the risk factors of postoperative encephalocele (P0.05). The GOS scores of the two groups after 6 months showed that the prognosis of the patients with delayed traumatic intracranial hematoma (DTICH) was worse than that of the non-exudation group (P0.05). The results of logistic regression analysis showed that 1. 837% GCS score (OR 1.837 CI = 1.021-3.304 P0.042), no artificial epidural desorption suture (OR 1.892), and delayed hemorrhage (OR2.147CI = 1.130-4.079P0.020) were the independent risk factors for postoperative encephalocele. Conclusion 1. The preoperative GCS score of patients with severe craniocerebral injury was low and no artificial epidural tension reduction suture was performed during the operation. Delayed haemorrhage increased the incidence of postoperative encephalocele. The half year prognosis of severe craniocerebral injury patients was worse than that of patients without encephalocele.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.15

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