外伤性脑积水的相关危险因素分析

发布时间：2018-02-02 08:35

本文关键词： 外伤性脑积水颅脑损伤去骨瓣减压蛛网膜下腔出血　出处：《皖南医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的：外伤性脑积水（posttraumatic hydrocephalus,PTH）是颅脑损伤(Traumatic brain injury,TBI)的主要合并症之一，严重地影响患者的预后及生活质量，对社会和个人造成严重的经济负担。本论文主要对TBI后脑积水的发生及其影响因素进行分析，，寻求相关危险因素，为预防TBI后脑积水的病发提供理论依据。方法:对2009年01月1日至2014年01月31日皖南医学院弋矶山医院神经外科收治的符合条件的240例颅脑损伤后的临床资料进行回顾分析。对患者的性别、年龄、入院时格拉斯哥昏迷评分（Glasgow Coma Scale,GCS）、蛛网膜下腔出血、颅内出血的部位（硬膜外、硬膜下及脑内）、手术方式（是否去除骨瓣）与脑积水的关系进行单因素及非条件多因素Logistic逐步回归法分析，采用SPSSl6.0软件进行统计学分析。结果：240例中46例（19.17%）发生脑积水，194例(81.83%)没有并发脑积水。46例PTH者的基本资料：男性34例(18.38%)，女性12例(21.82%)；年龄＜30岁8例（11.43%），30～50岁23例（18.40%），＞50岁15例（33.33%）；GCS评分10～15分4例（8.89%），GCS评分6～9分17例（17.53%），GCS评分3～5分25例（26.60%）；CT Fisher分级I～II级10例（10.20%），CT Fisher分级III～IV级36例（25.35%）；硬膜外出血2例（6.67%），硬膜下出血和颅内出血44例（23.40%）；术后31例病发脑积水的基本资料：去骨瓣减压者19例（31.15%），未去骨瓣减压者12例（14.63%）。194例没有病发PTH者的基本资料：男性151例(81.6%)，女性43例(78.18%)；年龄＜30岁62例（88.57%），30～50岁102例（81.60%），＞50岁30例（66.67%）；GCS评分10～15分45例（91.11%），GCS评分6～9分80例（82.47%），GCS评分3～5分69例（73.74%）；CT Fisher分级I～II级88例（89.80%），CT Fisher分级III～IV级106例；硬膜外出血28例（93.33%），硬膜下出血和颅内出血144例（76.60%）；术后112例未病发PTH的基本资料：去除骨瓣者42例（68.85%），未去骨瓣减压者70例（85.37%）。通过x2检验、Fish精确检验行单因素分析得出：患者年龄、入院GCS评分、蛛网膜下腔出血、去骨瓣减压、颅内血肿的部位是颅脑损伤后并发脑积水的重要影响因素，而性别与颅脑损伤后并发脑积水无相关性。Logistic逐步回归分析上述影响因素发现：年龄、蛛网膜下腔出血、去骨瓣减压、颅内血肿的部位与颅脑损伤后病发脑积水密切相关，而GCS评分与颅脑损伤后并发脑积水相关无统计学意义。结论：颅脑损伤患者中，外伤性脑积水的发生率19.17%；且需手术患者中，去骨瓣减压术后其发生率高达31.15%。患者的年龄、蛛网膜下腔出血、颅内血肿部位以及去骨瓣减压是颅脑损伤后脑积水产生的主要危险因素。
[Abstract]:Objective: to investigate the effect of posttraumatic hydrocephalus in traumatic hydrocephalus. PTH is one of the main complications of traumatic brain injury-TBI, which seriously affects the prognosis and quality of life of the patients. This paper mainly analyzes the occurrence of hydrocephalus after TBI and its influencing factors to find the related risk factors. To provide theoretical basis for prevention of hydrocephalus after TBI. Methods:. From January 1st 2009 to January 31st 2014, the clinical data of 240 patients with craniocerebral injury who were admitted to the Department of Neurosurgery, Yogi Mountain Hospital, Southern Anhui Medical College, were retrospectively analyzed. Sex. Age, Glasgow Coma scale, subarachnoid hemorrhage, and intracranial hemorrhage (epidural, subdural and intracerebral). The relationship between operation (removal of bone flap) and hydrocephalus was analyzed by univariate and unconditioned multivariate Logistic stepwise regression and statistical analysis by SPSSl6.0 software. Results hydrocephalus occurred in 46 out of 240 cases. Basic data of 46 cases of PTH without hydrocephalus: 34 cases were male and 12 cases were female. Age < 30 years 8 cases (11.43%) and 30 years old 23 cases (18.40%), > 50 years old 15 cases (33.33); The GCS score ranged from 10 to 15 in 4 cases (range from 8. 89) to 6 to 9 in 17 (17 / 17). The score of GCS was 3 ~ 5 in 25 (26. 60). Ct Fisher grade II grade (10 cases) and CT Fisher grade (36 cases) of III~IV grade (25. 35%); There were 2 cases of epidural hemorrhage, 6.67% of them, 44 cases of subdural hemorrhage and intracranial hemorrhage. The basic data of 31 cases of hydrocephalus after operation: 19 cases were decompressed with bone flap and 31. 15%). The basic data of 12 cases without bone flap decompression and without PTH: male 151 cases 81.6 cases female 43 cases 78.18 cases; The age of 62 cases < 30 years old was 88.57%. 102 cases of 30 years old were 81.60 years old, 30 cases were over 50 years old, and 66.67% of them were over 50 years old. The GCS score was 1015% in 45 cases (91.11) and 82.47% in 80 cases (82.47). The score was 73.74 in 69 cases. Ct Fisher grade II (88 cases) and CT Fisher grade (III~IV grade 106 cases); There were 28 cases of epidural hemorrhage (P < 93.33), 144 cases of subdural hemorrhage and intracranial hemorrhage (P < 0.05). The basic data of PTH in 112 cases without disease after operation were as follows: the bone flap was removed in 42 cases, the bone flap was removed in 42 cases and the bone flap was decompressed in 70 cases, and the bone flap was decompressed in 70 cases (85.37%). The results showed that the bone flap was removed by x2 test. Univariate analysis showed that age, admission GCS score, subarachnoid hemorrhage, decompression of bone flap and location of intracranial hematoma were the important influencing factors of hydrocephalus after craniocerebral injury. There was no correlation between sex and hydrocephalus after craniocerebral injury. Logistic stepwise regression analysis showed that age subarachnoid hemorrhage decompression of bone flap. The location of intracranial hematoma was closely related to hydrocephalus after craniocerebral injury, but GCS score had no significant correlation with hydrocephalus after craniocerebral injury. Conclusion: the incidence of traumatic hydrocephalus in patients with craniocerebral injury is 19.17. The incidence of decompression of bone flap was 31. 15%. The age of patients and subarachnoid hemorrhage. The location of intracranial hematoma and decompression of craniectomy were the main risk factors of hydrocephalus after craniocerebral injury.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R742.7

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