本文關(guān)鍵詞： 外傷性腦積水 顱腦損傷 去骨瓣減壓 蛛網(wǎng)膜下腔出血　出處：《皖南醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：外傷性腦積水（posttraumatic hydrocephalus,PTH）是顱腦損傷(Traumatic brain injury,TBI)的主要合并癥之一，嚴(yán)重地影響患者的預(yù)后及生活質(zhì)量，對(duì)社會(huì)和個(gè)人造成嚴(yán)重的經(jīng)濟(jì)負(fù)擔(dān)。本論文主要對(duì)TBI后腦積水的發(fā)生及其影響因素進(jìn)行分析，，尋求相關(guān)危險(xiǎn)因素，為預(yù)防TBI后腦積水的病發(fā)提供理論依據(jù)。 方法:對(duì)2009年01月1日至2014年01月31日皖南醫(yī)學(xué)院弋磯山醫(yī)院神經(jīng)外科收治的符合條件的240例顱腦損傷后的臨床資料進(jìn)行回顧分析。對(duì)患者的性別、年齡、入院時(shí)格拉斯哥昏迷評(píng)分（Glasgow Coma Scale,GCS）、蛛網(wǎng)膜下腔出血、顱內(nèi)出血的部位（硬膜外、硬膜下及腦內(nèi)）、手術(shù)方式（是否去除骨瓣）與腦積水的關(guān)系進(jìn)行單因素及非條件多因素Logistic逐步回歸法分析，采用SPSSl6.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果：240例中46例（19.17%）發(fā)生腦積水，194例(81.83%)沒有并發(fā)腦積水。46例PTH者的基本資料：男性34例(18.38%)，女性12例(21.82%)；年齡＜30歲8例（11.43%），30～50歲23例（18.40%），＞50歲15例（33.33%）；GCS評(píng)分10～15分4例（8.89%），GCS評(píng)分6～9分17例（17.53%），GCS評(píng)分3～5分25例（26.60%）；CT Fisher分級(jí)I～I(xiàn)I級(jí)10例（10.20%），CT Fisher分級(jí)III～I(xiàn)V級(jí)36例（25.35%）；硬膜外出血2例（6.67%），硬膜下出血和顱內(nèi)出血44例（23.40%）；術(shù)后31例病發(fā)腦積水的基本資料：去骨瓣減壓者19例（31.15%），未去骨瓣減壓者12例（14.63%）。194例沒有病發(fā)PTH者的基本資料：男性151例(81.6%)，女性43例(78.18%)；年齡＜30歲62例（88.57%），30～50歲102例（81.60%），＞50歲30例（66.67%）；GCS評(píng)分10～15分45例（91.11%），GCS評(píng)分6～9分80例（82.47%），GCS評(píng)分3～5分69例（73.74%）；CT Fisher分級(jí)I～I(xiàn)I級(jí)88例（89.80%），CT Fisher分級(jí)III～I(xiàn)V級(jí)106例；硬膜外出血28例（93.33%），硬膜下出血和顱內(nèi)出血144例（76.60%）；術(shù)后112例未病發(fā)PTH的基本資料：去除骨瓣者42例（68.85%），未去骨瓣減壓者70例（85.37%）。通過x2檢驗(yàn)、Fish精確檢驗(yàn)行單因素分析得出：患者年齡、入院GCS評(píng)分、蛛網(wǎng)膜下腔出血、去骨瓣減壓、顱內(nèi)血腫的部位是顱腦損傷后并發(fā)腦積水的重要影響因素，而性別與顱腦損傷后并發(fā)腦積水無(wú)相關(guān)性。Logistic逐步回歸分析上述影響因素發(fā)現(xiàn)：年齡、蛛網(wǎng)膜下腔出血、去骨瓣減壓、顱內(nèi)血腫的部位與顱腦損傷后病發(fā)腦積水密切相關(guān)，而GCS評(píng)分與顱腦損傷后并發(fā)腦積水相關(guān)無(wú)統(tǒng)計(jì)學(xué)意義。 結(jié)論：顱腦損傷患者中，外傷性腦積水的發(fā)生率19.17%；且需手術(shù)患者中，去骨瓣減壓術(shù)后其發(fā)生率高達(dá)31.15%�；颊叩哪挲g、蛛網(wǎng)膜下腔出血、顱內(nèi)血腫部位以及去骨瓣減壓是顱腦損傷后腦積水產(chǎn)生的主要危險(xiǎn)因素。
[Abstract]:Objective: to investigate the effect of posttraumatic hydrocephalus in traumatic hydrocephalus. PTH is one of the main complications of traumatic brain injury-TBI, which seriously affects the prognosis and quality of life of the patients. This paper mainly analyzes the occurrence of hydrocephalus after TBI and its influencing factors to find the related risk factors. To provide theoretical basis for prevention of hydrocephalus after TBI. Methods:. From January 1st 2009 to January 31st 2014, the clinical data of 240 patients with craniocerebral injury who were admitted to the Department of Neurosurgery, Yogi Mountain Hospital, Southern Anhui Medical College, were retrospectively analyzed. Sex. Age, Glasgow Coma scale, subarachnoid hemorrhage, and intracranial hemorrhage (epidural, subdural and intracerebral). The relationship between operation (removal of bone flap) and hydrocephalus was analyzed by univariate and unconditioned multivariate Logistic stepwise regression and statistical analysis by SPSSl6.0 software. Results hydrocephalus occurred in 46 out of 240 cases. Basic data of 46 cases of PTH without hydrocephalus: 34 cases were male and 12 cases were female. Age < 30 years 8 cases (11.43%) and 30 years old 23 cases (18.40%), > 50 years old 15 cases (33.33); The GCS score ranged from 10 to 15 in 4 cases (range from 8. 89) to 6 to 9 in 17 (17 / 17). The score of GCS was 3 ~ 5 in 25 (26. 60). Ct Fisher grade II grade (10 cases) and CT Fisher grade (36 cases) of III~IV grade (25. 35%); There were 2 cases of epidural hemorrhage, 6.67% of them, 44 cases of subdural hemorrhage and intracranial hemorrhage. The basic data of 31 cases of hydrocephalus after operation: 19 cases were decompressed with bone flap and 31. 15%). The basic data of 12 cases without bone flap decompression and without PTH: male 151 cases 81.6 cases female 43 cases 78.18 cases; The age of 62 cases < 30 years old was 88.57%. 102 cases of 30 years old were 81.60 years old, 30 cases were over 50 years old, and 66.67% of them were over 50 years old. The GCS score was 1015% in 45 cases (91.11) and 82.47% in 80 cases (82.47). The score was 73.74 in 69 cases. Ct Fisher grade II (88 cases) and CT Fisher grade (III~IV grade 106 cases); There were 28 cases of epidural hemorrhage (P < 93.33), 144 cases of subdural hemorrhage and intracranial hemorrhage (P < 0.05). The basic data of PTH in 112 cases without disease after operation were as follows: the bone flap was removed in 42 cases, the bone flap was removed in 42 cases and the bone flap was decompressed in 70 cases, and the bone flap was decompressed in 70 cases (85.37%). The results showed that the bone flap was removed by x2 test. Univariate analysis showed that age, admission GCS score, subarachnoid hemorrhage, decompression of bone flap and location of intracranial hematoma were the important influencing factors of hydrocephalus after craniocerebral injury. There was no correlation between sex and hydrocephalus after craniocerebral injury. Logistic stepwise regression analysis showed that age subarachnoid hemorrhage decompression of bone flap. The location of intracranial hematoma was closely related to hydrocephalus after craniocerebral injury, but GCS score had no significant correlation with hydrocephalus after craniocerebral injury. Conclusion: the incidence of traumatic hydrocephalus in patients with craniocerebral injury is 19.17. The incidence of decompression of bone flap was 31. 15%. The age of patients and subarachnoid hemorrhage. The location of intracranial hematoma and decompression of craniectomy were the main risk factors of hydrocephalus after craniocerebral injury.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R742.7

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