颅脑损伤后及去骨瓣减压术后发生脑积水的风险因素研究

发布时间：2019-01-06 13:24

【摘要】：研究背景：颅脑外伤是当前神经外科常见病及多发病之一,其中颅脑外伤后脑积水是颅脑外伤后病人导致病人致残率及致死率增高的重要原因之一。若不能得到及时有效地治疗,常会因颅内压力增高导致严重后果。脑积水定义为脑脊液生成及吸收失衡导致的脑室系统扩大,目前脑积水的分类方法较多,临床上最常用的分类方法为交通性及非交通性脑积水,主要依赖于脑脊液循环通路受阻的部位,若阻塞的部位是在蛛网膜颗粒以上,则阻塞部位以上的脑室扩大,称为非交通性脑积水,若阻塞部位在蛛网膜颗粒水平则为交通性脑积水,表现为所有脑室及蛛网膜下腔均扩大,该种分类方法有助于临床治疗方案的选择。脑积水形成的原因包括出血、脑膜炎、颅脑损伤等,因颅脑损伤受伤机制多样,因此颅脑外伤后脑积水的风险因素尚未全面系统地研究。其中重型颅脑损伤后行外伤性大骨瓣减压术已成为救治重型颅脑损伤的首选治疗方案,但随该手术方案在临床上的广泛应用,临床上发现术后脑积水发生成为治疗的难题,因此行术中及术后各环节寻找导致脑积水形成的危险因素。目的：本研究旨在探讨颅脑损伤后及去骨瓣减压术后导致脑积水形成的相关风险因素。揭示不同程度的颅脑损伤与脑积水形成的相关性及去骨瓣减压手术因素与脑积水形成之间的关系。方法：以2008年4月至2013年4月份收治的颅脑损伤的760例病人,跟踪随访其中发生脑积水的有126例,根据入院时患者的性别、是否昏迷、GCS评分,以及影像学资料中有无脑挫裂伤、蛛网膜下腔出血、硬膜外血肿、颅骨骨折、开放性颅脑损伤和脑脊液漏等因素,分别探究其与脑积水形成之间的关系。另外,在760例病人中有124例病人曾行去骨瓣减压术,通过比较分析了是否行早期手术、是否行双侧去骨瓣减压术、骨窗的面积及高度、是否早期行颅骨缺损修补术等因素与脑积水的发生有无相关性。结果：根据统计学分析得出昏迷程度及GCS评分、蛛网膜下腔出血、脑室出血及硬膜下出血等因素的差异均有统计学意义(p0.05)。通过对手术参数比较分析得出双侧去骨瓣减压术、骨窗高度及面积、二次手术、早期颅骨缺损修补等因素的差异均有统计学意义(p0.05)。结论：伤后昏迷程度,蛛网膜下腔出血,脑室出血,硬膜下出血,双侧去骨瓣减压术,骨窗的高度及面积,未能及时颅骨修补等因素为外伤后脑积水的风险因素。
[Abstract]:Background: craniocerebral trauma is one of the most common diseases in neurosurgery. Hydrocephalus after craniocerebral injury is one of the important reasons for the increase of disability rate and fatality rate in patients with craniocerebral trauma. If you can not get timely and effective treatment, often due to increased intracranial pressure leading to serious consequences. Hydrocephalus is defined as the enlargement of the ventricular system caused by the imbalance of cerebrospinal fluid production and absorption. There are many classification methods for hydrocephalus at present. The most commonly used classification methods in clinic are traffic hydrocephalus and non-communicating hydrocephalus. If the blocked area is above the arachnoid granule, the ventricle above the obstructed area is enlarged, which is called non-communicating hydrocephalus. If the location of obstruction is communicating hydrocephalus at the level of arachnoid granule, all ventricle and subarachnoid space are enlarged. This classification method is helpful to the choice of clinical treatment. The causes of hydrocephalus include hemorrhage meningitis craniocerebral injury and so on. Traumatic large bone flap decompression after severe craniocerebral injury has become the first choice in the treatment of severe craniocerebral injury. However, with the wide application of the surgical plan in clinical practice, the occurrence of hydrocephalus has become a difficult problem in the treatment of severe craniocerebral injury. Therefore, intraoperative and postoperative procedures were performed to find the risk factors leading to hydrocephalus. Objective: to investigate the risk factors of hydrocephalus after craniocerebral injury and bone flap decompression. To reveal the correlation between craniocerebral injury and hydrocephalus formation, and the relationship between the factors of decompression of bone flap and hydrocephalus formation. Methods: a total of 760 patients with craniocerebral injury admitted from April 2008 to April 2013 were followed up. 126 patients with hydrocephalus were followed up. According to the gender of the patients at the time of admission, whether they were unconscious or not, the GCS score was evaluated. The relationship between cerebral contusion and laceration, subarachnoid hemorrhage, epidural hematoma, skull fracture, open craniocerebral injury and cerebrospinal fluid leakage was investigated. In addition, 124 out of 760 patients had undergone decompression of bone flap. By comparison, we analyzed whether early operation, bilateral decompression of bone flap, area and height of bone window were performed. Whether early cranial defect repair is associated with hydrocephalus. Results: according to statistical analysis, there were significant differences in coma degree and GCS score, subarachnoid hemorrhage, intraventricular hemorrhage and subdural hemorrhage (p0.05). By comparing and analyzing the operation parameters, we found that there were significant differences in bilateral bone flap decompression, bone window height and area, secondary operation, early cranial defect repair and so on (p0.05). Conclusion: the risk factors of post-traumatic hydrocephalus were coma degree, subarachnoid hemorrhage, intraventricular hemorrhage, subdural hemorrhage, bilateral decompression of bone flap, height and area of bone window and failure to repair skull in time.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R651.15

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