摘要
目的分析总结创伤性脑损伤(TBI)患者术后并发脑积水的高危因素和治疗体会,为降低TBI术后并发脑积水的发生率以及改善治疗效果提供理论依据。方法选取空军军医大学西京医院神经外科重症监护室自2014年1月至2016年12月收治的TBI行标准去骨瓣减压术治疗的126例患者作为研究对象,对全部患者进行至少6个月随访,发生脑积水患者纳入脑积水组,未发生脑积水患者纳入对照组,回顾性分析术后脑积水发生率,比较分析TBI术后患者脑积水发生相关的高危因素,并观察脑室-腹腔分流术(VPS)对TBI并发脑积水患者的治疗效果。结果 126例患者中23例发生脑积水,并发脑积水时间为伤后1~10周。与对照组相比,脑积水组患者术前GCS评分较低(t=8.235,P<0.05),急性生理学与慢性健康评分系统Ⅱ评分较低(t=10.573,P<0.05),差异具有统计学意义。2组在年龄、昏迷时间、血肿部位(硬膜下、脑内)、蛛网膜下腔出血、脑室出血、中线偏移≥10 mm情况有着明显的不同,差异有统计学意义(P<0.05)。脑积水组患者行VPS治疗,28 d内恢复清醒状态,体温正常,无语言障碍。结论临床应为TBI患者术前进行术后并发脑积水高危因素的评估,预防脑积水的发生;若已发生,则可通过使用VPS来缓解患者的病情。
Objective:To analyze and summarize the high risk factors of hydrocephalus after surgery of traumatic brain injury(TBI)and therapeutic experiences,and to provide theoretical basis for the prevention of postoperative hydrocephalus.Methods To enroll 126 cases of TBI patients with standard decompressive craniectomy and follow up at least with 6 months about the complication rate of hydrocephalus.The related clinical characteristics were compared and the therapeutic results were observed after ventriculo-peritoneal shunt(VPS).Results Age,time of coma,lower GCS and high APACHEⅡscore when admission,location of hematoma,subarachnoid hemorrhage,intraventricular hemorrhage,lumbar puncture,intra-operative dura suture and midline shift more than 10 mm were the high risk factors of hydrocephalus after standard decompressive craniectomy of TBI patients.There were significant differences in these factors between hydrocephalus group and control group.After VPS was applied to treat the hydrocephalus patients,the patients recovered well in 30 d with normal temperature and without language dysfunction.Conclusion The high risk factors should be evaluated before the surgery of patients with TBI to prevent the complication of hydrocephalus.If there were,VPS is a suitable choice for the treatment.
作者
胡世颉
李兵
费舟
Hu Shijie;Li Bing;Fei Zhou(Department of Neurosurgery,Xijing Hospital,Fourth Military Medical University,Xi’an 710032,China)
出处
《中华神经创伤外科电子杂志》
2018年第1期16-19,共4页
Chinese Journal Of Neurotraumatic Surgery：Electronic Edition
基金
国家自然科学基金(81101710)
陕西省社会发展科技攻关项目(2015SF030)
陕西省国际科技合作与交流计划项目(2016KW-011)
关键词
创伤性脑损伤
脑积水
高危因素
脑室-腹腔分流术
Traumatic brain injury
Hydrocephalus
High risk factor
Ventriculo peritoneal shunt
