本文關鍵詞： 創(chuàng)傷性顱腦損傷 外傷后腦積水 危險因素　出處：《福建醫(yī)科大學》2013年碩士論文　論文類型：學位論文

【摘要】：目的：外傷后腦積水是創(chuàng)傷性顱腦損傷（Traumatic brain injury，TBI）的主要合并癥之一，嚴重地影響患者的生存質(zhì)量，對社會及個人造成沉重的經(jīng)濟負擔。本文主要對TBI后腦積水的形成及其影響因素進行分析以期發(fā)現(xiàn)危險因素并加以干預和控制減少外傷后腦積水的發(fā)生率。 方法：我院2007.09.01~2012.08.31住院治療的中、重型顱腦外傷患者，對其臨床及影像學特征進行分析并統(tǒng)計學上單因素及多因素回歸分析。 結(jié)果： 1.單因素分析發(fā)現(xiàn)患者年齡、入院時格拉斯哥昏迷評分（GCS）、去骨瓣減壓術、中線移位、是否合并蛛網(wǎng)膜下腔出血與外傷后硬膜下積液有關； 2.多因素回歸分析結(jié)果提示去骨瓣減壓術、中線移位、是否合并蛛網(wǎng)膜下腔出血與硬膜下積液密切相關，而年齡、入院時GCS則無關；去骨瓣減壓術的偏回歸系數(shù)是1.102，OR值3.010，，95%可信區(qū)間1.409~4.345；中線移位的偏回歸系數(shù)是1.072，OR值2.921，95%可信區(qū)間1.199~4.241；蛛網(wǎng)膜下腔出血的偏回歸系數(shù)是1.139，OR值3.124，95%可信區(qū)間1.506~4.857。 3.單因素分析發(fā)現(xiàn)入院時格拉斯哥昏迷評分、去骨瓣減壓術、瞳孔反應、中線移位、是否合并蛛網(wǎng)膜下腔出血、腦室血腫、是否合并硬膜下積液與外傷后腦積水有關； 4.多因素回歸分析結(jié)果提示入院時GCS、去骨瓣減壓術、是否合并蛛網(wǎng)膜下腔出血、腦室血腫、是否合并硬膜下積液與外傷后腦積水密切相關；入院時GCS的偏回歸系數(shù)是1.399，OR值4.051，95%可信區(qū)間2.606~6.297；去骨瓣減壓術的偏回歸系數(shù)是1.744，OR值0.009，95%可信區(qū)間3.484~9.387；蛛網(wǎng)膜下腔出血的偏回歸系數(shù)是3.272，OR值26.364，95%可信區(qū)間7.796~65.133；腦室血腫的偏回歸系數(shù)是1.859，OR值6.417，95%可信區(qū)間3.982~10.568；硬膜下積液的偏回歸系數(shù)是1.560，OR值4.759，95%可信區(qū)間3.169~7.611；其中雙側(cè)瞳孔無反應組的偏回歸系數(shù)是1.357，OR值3.884，95%可信區(qū)間1.108~6.247。 結(jié)論： 385例中、重型顱腦外傷患者，硬膜下積液118例，腦積水42例。 去骨瓣減壓術、中線移位、蛛網(wǎng)膜下腔出血是外傷性硬膜下積液的獨立風險因素； 入院時格拉斯哥昏迷評分、去骨瓣減壓術、腦室血腫、是否合并蛛網(wǎng)膜下腔出血、是否合并硬膜下積液是外傷后腦積水的獨立風險因素。針對上述措施進行干預以減少腦積水發(fā)生率，改善中重型顱腦損傷患者的預后有重要意義。
[Abstract]:Objective: hydrocephalus after trauma is one of the main complications of traumatic craniocerebral injury (TBI), which seriously affects the quality of life of the patients. This paper analyzes the formation of hydrocephalus after TBI and its influencing factors in order to find out the risk factors and control the incidence of post-traumatic hydrocephalus. Methods: the clinical and imaging features of patients with severe craniocerebral trauma in our hospital were analyzed and analyzed statistically by univariate and multivariate regression analysis. Results:. 1. Univariate analysis showed that age, Glasgow coma score at admission, bone flap decompression, midline displacement, and subarachnoid hemorrhage were associated with subdural effusion after trauma. 2.Multivariate regression analysis showed that decompression, midline displacement and subarachnoid hemorrhage were closely related to subdural effusion, but age, GCS at admission was not. The partial regression coefficient of decompression of bone flap was 1.010 ~ 95% confidence interval 1.409 ~ 4.345, the midline shift partial regression coefficient was 1.072OR 2.92195% confidence interval 1.1994.241, and the partial regression coefficient of subarachnoid hemorrhage was 1.139OR 3.12495% confidence interval 1.5064.857. 3. Univariate analysis showed that Glasgow coma score, decompression of bone flap, pupil reaction, midline displacement, subarachnoid hemorrhage, ventricular hematoma and subdural effusion were associated with post-traumatic hydrocephalus. 4. The results of multivariate regression analysis showed that GCS, decompression of bone flap, subarachnoid hemorrhage, ventricular hematoma and subdural effusion were closely related to post-traumatic hydrocephalus. The partial regression coefficient of GCS on admission was 4.05195% confidence interval 2.6066.297, the partial regression coefficient of bone flap decompression was 1.744U 95% confidence interval 3.48495% confidence interval 3.4849.387, the partial regression coefficient of subarachnoid hemorrhage was 3.272OR 26.36495% confidence interval 7.79665.133; The coefficient of OR was 6.4179.95% confidence interval 3.982n 10.568, the partial regression coefficient of subdural effusion was 1.560U OR 4.75995% confidence interval 3.1697.611, and the partial regression coefficient of bilateral pupillary non-response group was 1.357OR 3.88495% confidence interval 1.1084.247. Conclusion:. Of 385 cases, 118 cases were subdural effusion and 42 cases hydrocephalus. Decompression, midline displacement and subarachnoid hemorrhage were independent risk factors for traumatic subdural effusion. At admission, Glasgow coma score, bone flap decompression, ventricular hematoma, subarachnoid hemorrhage, Whether or not subdural effusion is an independent risk factor for post-traumatic hydrocephalus. It is important to intervene the above measures to reduce the incidence of hydrocephalus and improve the prognosis of patients with moderate and severe craniocerebral injury.
【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R651.15

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