切换至 "中华医学电子期刊资源库"
高级检索
中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2023, Vol. 09 ›› Issue (06) : 355 -359. doi: 10.3877/cma.j.issn.2095-9141.2023.06.007

临床研究

创伤性颅脑损伤患者保守治疗发生脑积水的危险因素分析
聂玉金, 曹培成†()   
  1. 261021　潍坊，山东第二医科大学临床医学院
    261021　潍坊，山东第二医科大学第一附属医院神经外科
  • 收稿日期:2022-06-05 出版日期:2023-12-15
  • 通信作者: 曹培成

Risk factors analysis for hydrocephalus occurring in patients with traumatic brain injury treated conservatively

Yujin Nie, Peicheng Cao†()   

  1. School of Clinical Medicine, Shandong Second Medical University, Weifang 261021, China
    Department of Neurosurgery, The First Affiliated Hospital of Shandong Second Medical University, Weifang 261021, China
  • Received:2022-06-05 Published:2023-12-15
  • Corresponding author: Peicheng Cao
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

聂玉金, 曹培成. 创伤性颅脑损伤患者保守治疗发生脑积水的危险因素分析[J]. 中华神经创伤外科电子杂志, 2023, 09(06): 355-359.

Yujin Nie, Peicheng Cao. Risk factors analysis for hydrocephalus occurring in patients with traumatic brain injury treated conservatively[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(06): 355-359.

目的

探讨创伤性颅脑损伤（TBI）患者保守治疗后发生创伤性脑积水（PTH）的危险因素。

方法

选取山东第二医科大学第一附属医院神经外科自2018年6月至2021年11月收治的168例行保守治疗的TBI患者作为研究对象，根据治疗后是否发生PTH将患者分为PTH组和非PTH组，比较2组患者的临床资料，并采用多因素Logistic回归模型分析PTH发生的危险因素。

结果

168例PTH患者中，PTH组46例，非PTH组122例。2组患者的年龄、创伤性蛛网膜下腔出血、脑室出血、入院GCS评分、颅内感染比较，差异有统计学意义（P<0.05）；进一步采用多因素Logistic回归分析显示，年龄≥56岁、创伤性蛛网膜下腔出血、脑室出血、入院时GCS评分<12分、颅内感染为TBI保守治疗后PTH发生的独立危险因素（P<0.05）。

结论

年龄≥56岁、创伤性蛛网膜下腔出血、脑室出血、入院时GCS评分<12分、颅内感染为TBI保守治疗后PTH发生的独立危险因素，临床应采取针对性的预防及治疗措施，以降低PTH的发生几率，改善患者的预后。

关键词: 创伤性脑积水, 创伤性颅脑损伤, 保守治疗, 危险因素
Objective

To investigate the risk factors for the occurrence of posttraumatic hydrocephalus (PTH) in patients with traumatic brain injury (TBI) treated conservatively.

Methods

From June 2018 to November 2021, 168 patients with TBI admitted to Neurosurgery Department of the First Affiliated Hospital of Shandong Second Medical University under conservative treatment were selected as the subjects of this study. Patients were divided into PTH group and non-PTH group based on whether PTH occurred after treatment. The clinical data of the two groups of patients were compared, and the multivariate Logistic regression model was used to analyze the risk factors for PTH occurrence.

Results

Among 168 patients, 46 cases of PTH occurred (PTH group), 122 cases of non occurring PTH (non-PTH group). There was a statistically significant difference in age, traumatic subarachnoid hemorrhage, ventricular hemorrhage, admission GCS score, and intracranial infection between the two groups of patients (P<0.05); Further multivariate Logistic regression analysis showed that age≥56 years, traumatic subarachnoid hemorrhage, intraventricular hemorrhage, GCS<12 score on admission, and intracranial infection were independent risk factors for PTH after conservative treatment with TBI (P<0.05).

Conclusion

Age≥56 years old, traumatic subarachnoid hemorrhage, intraventricular hemorrhage, GCS<12 score at admission, and intracranial infection are independent risk factors for PTH after conservative treatment of TBI. Targeted prevention and treatment measures should be taken clinically to reduce the incidence of PTH and improve patient prognosis.

Key words: Posttraumatic hydrocephalus, Traumatic brain injury, Conservative treatment, Risk factors
表1 2组患者的临床资料比较
Tab.1 Comparison of clinical data between two groups
项目 PTH组（n=46） 非PTH组（n=122） χ2值 P值
性别     1.473 0.102
男 26 68    
女 20 54    
年龄（岁）     5.835 0.016
≤56 25 90    
>56 21 32    
致伤原因     2.636 0.082
车祸伤 24 65    
坠落伤 11 31    
打击伤 6 13    
摔伤 3 8    
其他 2 5    
损伤类型     2.036 0.154
开放性 12 20    
闭合性 34 102    
创伤性蛛网膜下腔出血 34 25 4.652 0.031
脑室出血 28 33 3.792 0.046
入院时GCS评分（分）     4.531 0.034
3~7 12 10    
8~12 28 36    
13~15 6 76    
弥漫性轴索损伤 30 28 3.291 0.054
颅骨骨折 13 43 2.944 0.072
颅内感染 6 11 3.654 0.048
脑挫裂伤 12 47 2.528 0.086
硬膜下血肿 9 42 3.172 0.056
硬膜外血肿 7 46 1.873 0.091
表2 PTH相关危险因素的多重共线性检验（相关系数矩阵）
Tab.2 Multicollinearity test of PTH-related risk factors (Correlation coefficient matrix)
项目 标准差 年龄 创伤性蛛网膜下腔出血 脑室出血 入院时GCS评分 颅内感染
年龄 0.003 1        
创伤性蛛网膜下腔出血 0.046 0.4258 1      
脑室出血 0.021 0.3125 0.5341 1    
入院时GCS评分 0.009 0.3672 0.3419 0.3976 1  
颅内感染 0.015 0.2514 0.5197 0.6015 0.4725 1
表3 PTH相关危险因素的多重共线性检验（VIF矩阵）
Tab.3 Multicollinearity test of PTH-related risk factors (VIF matrix)
项目 VIF 容忍度
年龄 8.712 0.115
创伤性蛛网膜下腔出血 5.627 0.178
脑室出血 6.256 0.160
入院时GCS评分 4.389 0.228
颅内感染 7.257 0.138
表4 TBI后PTH发生的Logistic回归分析
Tab.4 Logistic regression analysis of PTH occurrence after TBI
因素 回归系数 标准误 Wald值 P值 OR值 95%CI
年龄（岁）            
<56         Ref（1）  
≥56 0.353 0.009 27.2 0.045 1.158 1.468~1.786
创伤性蛛网膜下腔出血 1.068 0.136 3.8 0.015 2.558 1.945~2.187
脑室出血 0.745 0.013 38.6 0.025 1.846 1.654~1.924
入院时GCS评分（分）          
≥12         Ref（1）  
<12 2.454 0.026 45.6 0.021 6.756 4.357~6.186
颅内感染 0.962 0.011 42.1 0.036 2.458 1.816~2.045
[1]
Maas AIR, Menon DK, Adelson PD, et al. Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research[J]. Lancet Neurol, 2017, 16(12): 987-1048. DOI: 10.1016/s1474-4422(17)30371-x.
[2]
Kanser RJ, O'Rourke JJF, Silva MA. Performance validity testing via telehealth and failure rate in veterans with moderate-to-severe traumatic brain injury: a veterans affairs TBI model systems study[J]. NeuroRehabilitation, 2021, 49(2): 169-177. DOI: 10.3233/nre-218019.
[3]
Ding C, Liu J, Liu K, et al. Relationship between prognosis with dynamic changes of thyroid hormone and cortisol hormone in patients with severe craniocerebral injury[J]. Evid Based Complement Alternat Med, 2022, 2022: 1883107. DOI: 10.1155/2022/1883107.
[4]
Di G, Hu Q, Liu D, et al. Risk factors predicting posttraumatic hydrocephalus after decompressive craniectomy in traumatic brain injury[J]. World Neurosurg, 2018, 116: e406-e413. DOI: 10.1016/j.wneu.2018.04.216.
[5]
Hannah EM, Zyck S, Hazama A, et al. Scoping review of the risk factors and time frame for development of post-traumatic hydrocephalus[J]. Rev Neurosci, 2022, 33(2): 133-146. DOI: 10.1515/revneuro-2021-0043.
[6]
刘佰运.创伤性脑积水的临床研究新进展[J].中华创伤杂志, 2014, 30(12): 1163-1164. DOI: 10.3760/cma.j.issn.1001-8050.2014.12.001.
[7]
解东成,陈红伟,王圣杰,等.创伤性脑损伤后不同程度脑积水患者脑室-腹腔分流术临床疗效分析[J].中华神经创伤外科电子杂志, 2021, 7(2): 92-95. DOI: 10.3877/cma.j.issn.2095-9141.2021.02.006.
[8]
Goldschmidt E, Deng H, Puccio AM, et al. Post-traumatic hydrocephalus following decompressive hemicraniectomy: Incidence and risk factors in a prospective cohort of severe TBI patients[J]. J Clin Neurosci, 2020, 73: 85-88. DOI: 10.1016/j.jocn.2020.01.027.
[9]
De Bonis P, Pompucci A, Mangiola A, et al. Post-traumatic hydrocephalus after decompressive craniectomy: an underestimated risk factor[J]. J Neurotrauma, 2010, 27(11): 1965-1970. DOI: 10.1089/neu.2010.1425.
[10]
Honeybul S, Ho KM. Incidence and risk factors for post-traumatic hydrocephalus following decompressive craniectomy for intractable intracranial hypertension and evacuation of mass lesions[J]. J Neurotrauma, 2012, 29(10): 1872-1878. DOI: 10.1089/neu.2012.2356.
[11]
Bonow RH, Oron AP, Hanak BW, et al. Post-traumatic hydrocephalus in children: a retrospective study in 42 pediatric hospitals using the pediatric health information system[J]. Neurosurgery, 2018, 83(4): 732-739. DOI: 10.1093/neuros/nyx470.
[12]
Jiao QF, Liu Z, Li S, et al. Influencing factors for posttraumatic hydrocephalus in patients suffering from severe traumatic brain injuries[J]. Chin J Traumatol, 2007, 10(3): 159-162.
[13]
Chen H, Yuan F, Chen SW, et al. Predicting posttraumatic hydrocephalus: derivation and validation of a risk scoring system based on clinical characteristics[J]. Metab Brain Dis, 2017, 32(5): 1427-1435. DOI: 10.1007/s11011-017-0008-2.
[14]
樊昕霖.颅脑创伤后继发脑积水的危险因素分析[D].南昌:南昌大学, 2022.
[15]
Carballo-Cuello C, de Jesus O, Fernandez-de Thomas RJ, et al. Posttraumatic hydrocephalus in pediatric patients after decompressive craniectomy[J]. World Neurosurg, 2020, 136: e690-e694. DOI: 10.1016/j.wneu.2020.01.153.
[16]
Zhuo J, Zhang W, Xu Y, et al. Nomogram for predicting post-traumatic hydrocephalus after decompressive craniectomy for traumatic brain injury[J]. Rev Assoc Med Bras (1992), 2022, 68(1): 37-43. DOI: 10.1590/1806-9282.20210392.
[17]
孙硕,周辉,施辉.颅脑外伤后脑积水的发生及相关危险因素的研究进展[J].医学综述, 2018, 24(9): 1739-1742, 1748. DOI: 10.3969/j.issn.1006-2084.2018.09.015.
[18]
Kammersgaard LP, Linnemann M, Tibæk M. Hydrocephalus following severe traumatic brain injury in adults. Incidence, timing, and clinical predictors during rehabilitation[J]. NeuroRehabilitation, 2013, 33(3): 473-480. DOI: 10.3233/nre-130980.
[19]
钱明,王学建,汪志峰,等.不同手术方式治疗脑外伤术后脑积水患者的效果[J].实用医学杂志, 2017, 33(15): 2601-2603. DOI: 10.3969/j.issn.1006-5725.2017.15.046.
[20]
张雄新,李玉雄.闭合性颅脑损伤患者并发进展性出血性损伤危险因素分析[J].解放军医药杂志, 2017, 29(12): 49-52. DOI: 10.3969/j.issn.2095-140X.2017.12.014.
[21]
丁锦荣,管义祥,吴德模,等.重型颅脑损伤并发脑积水的相关因素分析[J].中国综合临床, 2016, 32(6): 552-554. DOI: 10.3760/cma.j.issn.1008-6315.2016.06.022.
[22]
Linnemann M, Tibæk M, Kammersgaard LP. Hydrocephalus during rehabilitation following severe tbi. Relation to recovery, outcome, and length of stay[J]. NeuroRehabilitation, 2014, 35(4): 755-761. DOI: 10.3233/nre-141160.
[1] 刘欢颜, 华扬, 贾凌云, 赵新宇, 刘蓓蓓. 颈内动脉闭塞病变管腔结构和血流动力学特征分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 809-815.
[2] 马艳波, 华扬, 刘桂梅, 孟秀峰, 崔立平. 中青年人颈动脉粥样硬化病变的相关危险因素分析[J]. 中华医学超声杂志（电子版）, 2023, 20(08): 822-826.
[3] 唐旭, 韩冰, 刘威, 陈茹星. 结直肠癌根治术后隐匿性肝转移危险因素分析及预测模型构建[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 16-20.
[4] 吴方园, 孙霞, 林昌锋, 张震生. HBV相关肝硬化合并急性上消化道出血的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 45-47.
[5] 陈旭渊, 罗仕云, 李文忠, 李毅. 腺源性肛瘘经手术治疗后创面愈合困难的危险因素分析[J]. 中华普外科手术学杂志(电子版), 2024, 18(01): 82-85.
[6] 晏晴艳, 雍晓梅, 罗洪, 杜敏. 成都地区老年转移性乳腺癌的预后及生存因素研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 636-638.
[7] 莫闲, 杨闯. 肝硬化患者并发门静脉血栓危险因素的Meta分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 678-683.
[8] 王明, 杨程凯, 吴小雅, 沈佳佳, 黄兴华, 吕立志, 蔡秋程, 杨芳, 刘建勇, 江艺. 逆灌注法DCD供肝对肝移植术后早期肝功能恢复的影响及危险因素分析[J]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 33-38.
[9] 苏日顺, 卢逸, 庄宝鼎, 张译, 李彦杰, 徐见亮. 肝硬化脾亢脾切除术后门静脉血栓形成影响因素[J]. 中华肝脏外科手术学电子杂志, 2024, 13(01): 39-44.
[10] 倪文凯, 齐翀, 许小丹, 周燮程, 殷庆章, 蔡元坤. 结直肠癌患者术后发生延迟性肠麻痹的影响因素分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 484-489.
[11] 张雯, 宋牡丹, 邓雪婷, 张云. 强化营养支持辅助奥曲肽治疗肝硬化合并食管胃底静脉曲张破裂出血的疗效及再出血危险因素[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 456-460.
[12] 陈润祥, 张大涯, 陈世锔, 张晓冬, 黄士美, 陈晨, 李达, 曾凡, 白飞虎. 281例消化性溃疡出血的临床特征[J]. 中华临床医师杂志(电子版), 2023, 17(11): 1147-1153.
[13] 陆猛桂, 黄斌, 李秋林, 何媛梅. 蜂蛰伤患者发生多器官功能障碍综合征的危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(09): 1010-1015.
[14] 李达, 张大涯, 陈润祥, 张晓冬, 黄士美, 陈晨, 曾凡, 陈世锔, 白飞虎. 海南省东方市幽门螺杆菌感染现状的调查与相关危险因素分析[J]. 中华临床医师杂志(电子版), 2023, 17(08): 858-864.
[15] 李琪, 黄钟莹, 袁平, 关振鹏. 基于某三级医院的ICU多重耐药菌医院感染影响因素的分析[J]. 中华临床医师杂志(电子版), 2023, 17(07): 777-782.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号