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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
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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/OL]. 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/OL]. 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
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