颅脑损伤手术中急性脑膨出的形成原因初步探讨

发布时间：2018-10-21 11:41

【摘要】：目的探究颅脑损伤手术中急性脑膨出的形成原因及影响因素,提出有效防治措施。方法选取2014年1月至2016年1月我院神经外科实施开颅手术的颅脑损伤患者130例,根据术中是否发生急性脑膨出分为观察组(发生急性脑膨出)和对照组(未发生急性脑膨出)。收集患者的临床资料,通过单因素卡方检验和多因素Logistic回归分析总结颅脑损伤患者术中发生急性脑膨出的影响因素。结果 40例患者术中发生急性脑膨出,发生率为30.8%。经单因素卡方检验,两组患者性别比、年龄、致伤原因、有无脑脊液漏以及合并多发伤情况差异均无统计学意义(P0.05);观察组入院后首次格拉斯哥昏迷评分(glasgow coma scale,GCS)8分、受伤至手术时间3 h、合并手术远隔部位颅骨骨折、合并迟发性外伤性颅内血肿(delayed traumatic intracranial hematoma,DTIH)以及合并外伤性弥漫性脑肿胀(post-traumatic acute diffuse brain swelling,PADBS)的比例均高于对照组,差异均有统计学意义(P0.05)。经多因素Logistic回归分析,入院后首次GCS评分低、受伤至手术时间短以及合并手术远隔部位颅骨骨折、DTIH和PADBS均为颅脑损伤患者术中发生急性脑膨出的危险因素。结论颅脑损伤患者手术过程中发生急性脑膨出的几率较高,且与入院后首次GCS评分、受伤至手术时间以及合并手术远隔部位颅骨骨折、DTIH和PADBS情况相关,术前应对患者发生急性脑膨出的风险进行综合评估。
[Abstract]:Objective to investigate the causes and influencing factors of acute encephalocele in craniocerebral injury surgery and to put forward effective prevention and treatment measures. Methods 130 patients with craniocerebral injury underwent craniotomy in our hospital from January 2014 to January 2016 were divided into observation group (acute encephalocele) and control group (no acute encephalocele) according to whether acute encephalocele occurred or not. The clinical data of the patients were collected and the influencing factors of acute encephalocele in patients with craniocerebral injury were summarized by single factor chi-square test and multivariate Logistic regression analysis. Results Acute encephalocele occurred in 40 cases, the incidence was 30.8%. After univariate chi-square test, there was no significant difference in sex ratio, age, cause of injury, cerebrospinal fluid leakage and complicated multiple injury between the two groups (P0.05); the observation group had 8 points of Glasgow coma score (glasgow coma scale,GCS) after admission. The ratio of traumatic diffuse brain swelling (post-traumatic acute diffuse brain swelling,PADBS) and delayed traumatic intracranial hematoma (delayed traumatic intracranial hematoma,DTIH) was significantly higher than that of the control group (P0.05). Multivariate Logistic regression analysis showed that the first GCS score was low, the time from injury to operation was short, and the cranial fracture of distant site was complicated by operation. Both DTIH and PADBS were the risk factors for acute encephalocele in patients with craniocerebral injury. Conclusion the incidence of acute encephalocele in patients with craniocerebral injury during operation is higher, and it is related to the first GCS score after admission, the time from injury to operation, the fracture of skull in distant site, DTIH and PADBS. Preoperative risk of acute encephalocele should be comprehensively assessed.
【作者单位】：江苏省盐城市第一人民医院神经外科;
【分类号】：R651.15

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