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目的分析重度颅脑损伤(severe traumatic brain injury,STBI)患者术后并发脑积水的相关因素。方法回顾性分析2010年1月~2015年12月收治的327例STBI患者,均接受头颅CT检查,其中术后并发脑积水者60例,其余267例未并发脑积水,分析并发脑积水的相关因素。结果单因素分析显示,年龄超过50岁、入院时GCS评分为3~5分、未行腰椎穿刺、血肿位置在硬膜下和脑内、行去骨瓣减压、开颅但未行硬膜缝合、SAH为弥漫性的患者术后脑积水发生率高于年龄小于或等于50岁、入院时GCS评分为6~8分、行腰椎穿刺、血肿位置在硬膜外、未行去骨瓣减压、开颅并行硬膜缝合、SAH为局限性的患者,差异显著,P<0.05。多因素回归分析显示,STBI术后并发脑积水的保护因素包括行腰椎穿刺和开颅者行硬膜缝合,危险因素包括SAH呈弥散性、行去骨瓣减压与年龄超过50岁,差异显著,P<0.05。结论 STBI患者术后并发脑积水的几率较高,且受到多方面因素共同影响,不利于患者的治疗与恢复,临床上应尤其注意高危患者,可采取腰椎穿刺、硬膜缝合措施预防脑积水。
Objective To analyze the related factors of postoperative hydrocephalus in patients with severe traumatic brain injury (STBI). Methods A total of 327 STBI patients admitted from January 2010 to December 2015 were retrospectively analyzed. CT scans were performed in 60 patients with postoperative hydrocephalus and the remaining 267 patients without concomitant hydrocephalus. Water related factors. Results Univariate analysis showed that patients over 50 years of age had a GCS score of 3 to 5 at admission. Lumbar puncture was not performed. The hematoma was located subdurally and intracerebroventricularly with decompressive craniectomy and craniotomy without dura mater The incidence of postoperative hydrocephalus in patients with diffuse SAH was significantly higher than that of patients younger than or equal to 50 years old. The GCS score at admission was 6 to 8 points. Lumbar puncture was performed on the epidural hematoma site, Decompression, craniotomy parallel dura suture, SAH patients with limitations, significant difference, P <0.05. Multivariate regression analysis showed that the protective factors of hydrocephalus after STBI include lumbar puncture and craniotomy for dura suture. The risk factors include diffuse SAH, decompression of ciliary flap over 50 years of age, difference Significantly, P <0.05. Conclusions The incidence of postoperative hydrocephalus in STBI patients is high, and it is affected by many factors and is not conducive to the treatment and recovery of patients. In clinical practice, high-risk patients should be especially noticed, and lumbar puncture and dura suture can be used to prevent cerebrospinal fluid water.