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目的 :分析多个危险因素与外伤后迟发性脑积水发生的关系,为临床预防与治疗提供依据。方法 :回顾性分析明确诊断的193例颅脑外伤患者,并分别对其GCS评分、脑挫裂伤、开颅去骨瓣减压、蛛网膜下腔出血、脑室出血、腰穿/腰大池持续脑脊液外引流与外伤后迟发性脑积水发生之间的关系,进行单因素和多因素的Logistic分析。结果:35例(18.1%)颅脑外伤患者发生了迟发性脑积水,Logistic回归分析发现,GCS评分、脑室出血、去骨瓣减压、腰穿/腰大池持续脑脊液外引流为影响外伤后迟发性脑积水发生的相关因素(P<0.05),其中腰穿/腰大池持续脑脊液外引流为其保护因素(P=0.024)。结论:外伤后昏迷程度、脑室出血、去骨瓣减压是外伤后迟发性脑积水形成的危险因素,而早期进行腰穿或腰大池持续脑脊液外引流可明显减少脑积水的发生。
Objective: To analyze the relationship between multiple risk factors and the occurrence of delayed hydrocephalus after trauma, and provide the basis for clinical prevention and treatment. Methods: A total of 193 patients with craniocerebral injury were retrospectively analyzed. The GCS score, contusion and loosening of brain, decompression of craniotomy, decompression of subarachnoid hemorrhage, intraventricular hemorrhage, and lumbar puncture / The relationship between cerebrospinal fluid drainage and posttraumatic delayed hydrocephalus was analyzed by single factor and multivariate logistic analysis. Results: Delayed hydrocephalus occurred in 35 patients (18.1%) with traumatic brain injury. Logistic regression analysis showed that GCS score, intraventricular hemorrhage, decompressive craniectomy, persistent lumbar puncture / (P <0.05). The lumbar puncture / lumbar cistern was the protective factor of continuous cerebrospinal fluid drainage (P = 0.024). CONCLUSION: Post-traumatic coma, ventricular hemorrhage and decompressive craniectomy are risk factors for delayed hydrocephalus after trauma. Early continuous drainage of cerebrospinal fluid by lumbar puncture or lumbar cistern can significantly reduce the incidence of hydrocephalus.