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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2022, Vol. 08 ›› Issue (03) : 155 -160. doi: 10.3877/cma.j.issn.2095-9141.2022.03.005

临床研究

脑室外引流后穿刺道出血的危险因素分析
沈军1,†(), 许文庆1, 付彬1, 郑相虎1, 张静1   
  1. 1. 236000　阜阳市肿瘤医院神经外科
  • 收稿日期:2022-01-25 出版日期:2022-06-15
  • 通信作者: 沈军

Risk factors of hemorrhage associated with external ventricular drainage

Jun Shen1,†(), Wenqing Xu1, Bin Fu1, Xianghu Zheng1, Jing Zhang1   

  1. 1. Department of Neurosurgery, Fuyang Cancer Hospital, Fuyang 236000, China
  • Received:2022-01-25 Published:2022-06-15
  • Corresponding author: Jun Shen
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沈军, 许文庆, 付彬, 郑相虎, 张静. 脑室外引流后穿刺道出血的危险因素分析[J/OL]. 中华神经创伤外科电子杂志, 2022, 08(03): 155-160.

Jun Shen, Wenqing Xu, Bin Fu, Xianghu Zheng, Jing Zhang. Risk factors of hemorrhage associated with external ventricular drainage[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(03): 155-160.

目的

探讨脑室外引流后穿刺道出血的危险因素，为预防和早期诊治脑室外引流后穿刺道出血提供理论依据。

方法

回顾性分析阜阳市肿瘤医院神经外科自2018年1月至2021年5月收治的脑室外引流手术患者114例，根据其有无穿刺道出血分为出血组（28例）及未出血组（86例）。比较2组患者的基线资料，并将单因素分析中有统计学意义的因素纳入多因素Logistic回归分析，探究脑室外引流后穿刺道出血的独立危险因素。

结果

单因素分析结果显示，出血组患者年龄、脑卒中史、术前抗血小板药物、术前抗凝药物穿刺次数高于未出血组，同期颅脑手术率低于未出血组，差异均有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，术前抗血小板药物（OR=7.205，95%CI：2.243~23.144）、穿刺次数（OR=2.473，95%CI：1.315~4.650）是脑室外引流后穿刺道出血的独立危险因素，而同期颅脑手术（OR=0.163，95%CI：0.038~0.702）是脑室外引流后穿刺道出血的独立保护因素。

结论

术前抗血小板药物和穿刺次数是脑室外引流后穿刺道出血的独立危险因素，同期颅脑手术是脑室外引流后穿刺道出血的独立保护因素，临床中应注意积极预防、早期干预。

关键词: 脑室外引流, 穿刺道出血, 危险因素, 回顾性研究
Objective

To investigate the risk factors of hemorrhage associated with external ventricular drainage (EVD), and to provide theoretical basis for the prevention and early diagnosis and treatment of hemorrhage associated with EVD.

Methods

A retrospective analysis was made of 114 patients with extraventricular drainage surgery admitted to Neurosurgery Department of Fuyang Cancer Hospital from January 2018 to May 2021. They were divided into bleeding group (28 cases) and non bleeding group (86 cases) according to whether they had hemorrhage associated with EVD. The baseline data of the two groups were compared, and then the factors with statistical significance in univariate analysis were included in multivariate Logistic regression analysis to explore the independent risk factors of hemorrhage associated with EVD.

Results

The results of univariate analysis showed that the age, previous stroke rate, preoperative antiplatelet drug use rate, preoperative anticoagulant drug use rate and puncture times of patients in the bleeding group were higher than those in the non bleeding group, and the concurrent brain surgery rate was lower than in the non bleeding group, with significant differences (P<0.05). The results of multivariate Logistic regression analysis showed that the use of preoperative antiplatelet drugs (OR=7.205, 95%CI:2.243-23.144) was a protective factor, while the number of punctures (OR=2.473, 95%CI: 1.315-4.650) and concurrent craniocerebral surgery (OR=0.163, 95%CI: 0.038-0.702) was a possible independent protective factor for puncture tract hemorrhage after extraventricular drainage (P<0.05).

Conclusion

Preoperative use of antiplatelet drugs is a protective factor, while the number of puncture times and simultaneous craniocerebral surgery may be independent risk factors for puncture hemorrhage after extraventricular drainage, so attention should be paid to active prevention and early intervention in clinical practice.

Key words: External ventricular drainage, Cerebral hemorrhage, Risk factors, Retrospective studies
表1 2组患者的一般资料比较
项目 出血组(n=28) 未出血组(n=86) t/χ2/Z值 P值
年龄（岁，±s） 61.75±14.60 53.71±17.83 2.161 0.033
性别[例(%)]     2.556 0.110
  男 21(75.0) 50(58.1)    
  女 7(25.0) 36(41.9)    
入院诊断[例(%)]     8.434 0.099
  脑出血 20(71.4) 50(58.1) 1.574 0.210
  颅脑创伤 1(3.6) 11(12.8) 1.053 0.305
  动脉瘤性蛛网膜下腔出血 4(14.3) 13(15.1) 0 1.000
  脑肿瘤 0(0.0) 9(10.5) 1.905 0.168
  脑梗死 3(10.7) 2(2.3) 1.826 0.177
  感染 0(0.0) 1(1.2)   1.000
入院GCS评分[M(P25，P75)] 7.25(5.25,13.00) 7.00(5.00,12.00) -0.817 0.414
高血压[例(%)] 17(60.7) 51(59.3) 0.017 0.895
糖尿病[例(%)] 7(25.0) 14(16.3) 1.069 0.301
吸烟[例(%)] 6(21.4) 18(20.9) 0.003 0.955
饮酒[例(%)] 6(21.4) 17(19.8) 0.036 0.849
脑卒中史[例(%)] 11(39.3) 16(18.6) 4.998 0.025
术前抗血小板药物[例(%)] 11(39.3) 9(10.5) 12.129 <0.001
术前抗凝药物[例(%)] 3(10.7) 1(1.2)   0.045
脑室外引流[例(%)] 2(7.1) 17(19.8) 1.600 0.206
双侧穿刺[例(%)] 4(14.3) 14(16.3) 0.000 1.000
穿刺次数[M(P25，P75)] 1.00(1.00,3.00) 1.00(1.00,2.00) -2.207 0.027
同期颅脑手术[例(%)] 3(10.7) 30(34.9) 5.999 0.014
表2 脑室外引流后穿刺道出血影响因素的多因素Logistic回归分析
因素 偏回归系数 标准误 Wald χ2值 P值 OR值 95%CI
年龄 0.812 0.128 3.816 0.925 5.933 4.661~7.022
脑卒中史 0.723 0.874 8.175 1.147 6.174 7.369~8.142
术前抗凝药物 0.857 0.632 4.326 2.456 9.175 9.962~12.374
术前抗血小板药物史 1.975 0.595 11.001 0.001 7.205 2.243~23.144
穿刺次数 0.905 0.322 7.901 0.005 2.473 1.315~4.650
同期颅脑手术 -1.811 0.744 5.929 0.015 0.163 0.038~0.702
表3 抗血小板组与未出血组穿刺道出血体积比较（mL）
组别 例数 出血体积[M(P25，P75)] 中位数差值(95%CI)
抗血小板组 11 0.75(0.20,1.77) -0.800~0.280
未抗血小板组 17 0.50(0.22,0.74)
Z值   0.541
P值   0.588
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