Risk factors for acute encephalocele during operation in patients with post-traumatic acute diffuse brain swelling

doi:10.3877/cma.j.issn.2095-9141.2016.04.006

Abstract

Abstract:

Objective

To explore the risk factors of acute encephalocele during operation in patients with PADBS(post-traumatic acute diffuse brain swelling).

Methods

Gender, age, time from injured to operation,deceleration craniocerebral injury, multiple injuries,cranial CT scan hematoma thickness,hernia, GCS scale before operation, hypotension during operation, operation methods were recorded and analyzed the risk factors in 58 acute encephalocele during operation in patients with PADBS(study group)and 47 patients without acute encephalocele (control group)by multi-factor regression analysis.

Results

Deceleration craniocerebral injury, hernia, GCS scale before operation, hypotension during operation were closely correlated with the occurrence of acute encephalocele during operation.

Conclusions

Deceleration craniocerebral injury, hernia, GCS scale before operation, hypotension during operation are the risk factors for acute encephalocele during operation. Precise evaluation before operation and active control during operation will reduce the risk of acute encephalocele during operation in patients with PADBS.

Key words: Brain edema, Encephalocele, Risk factors, Pathogenesis

Jin Sun, Junqing Zhang, Yanlin Huang, Xinhua Tian. Risk factors for acute encephalocele during operation in patients with post-traumatic acute diffuse brain swelling[J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2016, 02(04): 215-219.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsjcswkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-9141.2016.04.006

https://zhsjcswkdzzz.cma-cmc.com.cn/EN/Y2016/V02/I04/215

Figures/Tables 3

References 17

[1]	Yoshino E,Yamaki T,Higuchi T, et al. Acute brain edema in fatal head injury: analysis by dynamic CT scanning[J]. J Neurosurg, 1985, 63(6）: 830-839.
[2]	Soustiel JF,Sviri GE,Mahamid E, et al. Cerebral blood flow and metabolism following decompressive craniectomy for control of increased intracranial pressure[J]. Neurosurgery, 2010, 67(1): 65-72.
[3]	Losiniecki A,Shutter L. Management of traumatic brain injury[J]. Curr Treat Options Neurol, 2010, 12(2): 142-154.
[4]	Marshall LF,Marshall SB,Klaube MR, et al. The diagnosis of head injury requires a classification based on computed axial tomography[J]. J Neurotrauma, 1992, 9 Suppl 1: S287-S292.
[5]	Csokay A,Emelifeonwu JA,Fugedi L, et al. The importance of very early decompressive craniectomy as a prevention to avoid the sudden increase of intracranial pressure in children with severe traumatic brain swelling (retrospective case series)[J]. Childs Nerv Syst, 2012, 28(3): 441-444.
[6]	Sahuquillo J,Poca MA,Amoros S. Current aspects of pathophysiology and cell dysfunction after severe head injury[J]. Curr Pharm Des, 2001, 7(15): 1475-1503.
[7]	Balestreri M,Czosnyka M,Hutchinson P, et al. Impact of intracranial pressure and cerebral perfusion pressure on severe disability and mortality after head injury[J]. Neurocrit Care, 2006, 4(1): 8-13.
[8]	Daboussi A,Minville V,Leclerc-Foucras S, et al. Cerebral hemodynamic changes in severe head injury patients undergoing decompressive craniectomy[J]. J Neurosurg Anesthesiol, 2009, 21(4): 339-345.
[9]	Xu FH,Chen WJ,Yang YJ, et al. Evaluation of multislice computed tomographic perfusion imaging and computed tomographic angiography on traumatic cerebral infarction[J]. Chin J Traumatol, 2008, 11(3): 186-189.
[10]	何黎民,卢亦成,吴建国,等.额、枕部直接冲击导致中脑损伤的力学机制研究[J].中华神经外科杂志, 2007, 23(07): 493-495.
[11]	Beeker DP,Gade GF,Young HF. Intracranial heamatoma. In：Youmam JR eds. Neurological Surgery[M]. Philadephia: Saunders，1990, 2079-2080.
[12]	Li LM,Timofeev I,Czosnyka M, et al.Review article: the surgical approach to the management of increased intracranial pressure after traumatic brain injury[J]. Anesth Analg, 2010, 111(3): 736-748.
[13]	Salluh JI,Martins GA,Santino MS, et al. Early use of terlipressin in catecholamine-resistant shock improves cerebral perfusion pressure in severe traumatic brain injury[J]. Acta Anaesthesiol Scand, 2007, 51(4): 505-508.
[14]	江基尧,朱诚,罗其中,主编.颅脑创伤临床救治指南[M].第3版,上海第二军医大学出版社, 2007: 129-136.
[15]	Graham DI,McIntosh TK,Maxwell WL, et al. Recent advances in neurotrauma[J]. J Neuropathol Exp Neurol, 2000, 59(8): 641-651.
[16]	Bao YH,Liang YM,Gao GY, et al. Bilateral decompressive craniectomy for patients with malignant diffuse brain swelling after severe traumatic brain injury: a 37-case study[J]. J Neurotrauma, 2010, 27(2): 341-347.
[17]	Zheng W,Wei Q,Qin J, et al. CT finding is an index in assessment of outcome in patients with diffuse traumatic brain swelling[J]. Chin J Traumatol, 2000, 3(1): 23-25.

因素	变量名	赋值
性别	X1	男=1,女=2
年龄	X2	≤16岁：0，17~60岁：1，>60岁：2
受伤至手术时间	X3	≤6 h:0,>6h:1
减速性颅脑损伤	X4	否：0，是：1
合并多发伤	X5	无：0，是：1
头颅CT血肿厚度	X6	≤10 mm:0,>10 mm:1
脑疝	X7	无：0，是：1
术前GCS评分	X8	3~5分:0,6分以上：1
术中低血压	X9	无：0，是：1
手术方式	X10	单侧去骨瓣：0，双侧去骨瓣：1
外伤后急性弥漫性脑肿胀	Y	对照：0，病例：1

因素	变量名	赋值
性别	X1	男=1,女=2
年龄	X2	≤16岁：0，17~60岁：1，>60岁：2
受伤至手术时间	X3	≤6 h:0,>6h:1
减速性颅脑损伤	X4	否：0，是：1
合并多发伤	X5	无：0，是：1
头颅CT血肿厚度	X6	≤10 mm:0,>10 mm:1
脑疝	X7	无：0，是：1
术前GCS评分	X8	3~5分:0,6分以上：1
术中低血压	X9	无：0，是：1
手术方式	X10	单侧去骨瓣：0，双侧去骨瓣：1
外伤后急性弥漫性脑肿胀	Y	对照：0，病例：1

相关因素	回归系数	标准误	Wald值	P值	Exp (B)	95%置信区间
减速性颅脑损伤	1.748	0.775	5.093	0.024	5.745	1.259~26.222
脑疝	1.252	0.611	4.193	0.041	3.498	1.055~11.596
术前GCS评分	-1.527	0.529	8.324	0.004	0.217	0.077~0.613
术中低血压	2.31	1.158	3.978	0.046	10.075	1.041~97.507

相关因素	回归系数	标准误	Wald值	P值	Exp (B)	95%置信区间
减速性颅脑损伤	1.748	0.775	5.093	0.024	5.745	1.259~26.222
脑疝	1.252	0.611	4.193	0.041	3.498	1.055~11.596
术前GCS评分	-1.527	0.529	8.324	0.004	0.217	0.077~0.613
术中低血压	2.31	1.158	3.978	0.046	10.075	1.041~97.507

Please choose a citation manager

Content to export