神经外科康复单元脑外伤后脑积水发生危险因素分析

doi:10.3969/j.issn.1006-9771.2020.09.015

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (9): 1083-1088.doi: 10.3969/j.issn.1006-9771.2020.09.015

神经外科康复单元脑外伤后脑积水发生危险因素分析

胡安明¹,王宇^2,³,孙炜^2,³()

1.首都医科大学附属北京天坛医院康复医学科,北京市 100070
2.中国康复研究中心北京博爱医院神经外科,北京市 100068
3.首都医科大学康复医学院,北京市 100068

收稿日期:2020-02-28 修回日期:2020-05-11 出版日期:2020-09-25 发布日期:2020-09-24
通讯作者: 孙炜 E-mail:sunwei7777@126.com
作者简介:胡安明(1977-),男,汉族,山东济南市人,博士,主治医师,主要研究方向：神经康复|王宇(1976-),女,汉族,河北唐山市人,硕士,主治医师,主要研究方向：颅脑损伤、脑血管疾病的早期救治及恢复期治疗。
基金资助:
北京市医院管理中心临床医学发展专项(ZYLX201836)

Risk Factors Related to Hydrocephalus Following Traumatic Brain Injury in Neurosurgical Rehabilitation Unit

HU An-ming¹,WANG Yu^2,³,SUN Wei^2,³()

1. Department of Rehabilitation Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
2. Neurosurgery Department, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China

Received:2020-02-28 Revised:2020-05-11 Published:2020-09-25 Online:2020-09-24
Contact: SUN Wei E-mail:sunwei7777@126.com
Supported by:
Beijing Municipal Administration of Hospitals Clinical Medicine Development Special Funding(ZYLX201836)

摘要/Abstract

摘要：

目的研究康复机构神经外科康复单元中脑外伤后发生创伤后脑积水相关危险因素。
方法 2016年1月1日至2017年12月31日,在中国康复研究中心北京博爱医院神经外科住院的脑外伤康复患者176例,根据入院诊断分为脑积水组和非脑积水组。采用单因素分析和Logistic多元回归法分析相关因素。
结果脑积水发生率为46%。创伤性蛛网膜下腔出血(OR = 4.127, 95%CI 1.742~9.776)、病程(OR = 3.377, 95%CI 2.281~5.000)和受伤后手术时间(OR = 2.265, 95%CI 1.076~4.770)是发生创伤后脑积水的独立危险因素。
结论创伤后脑积水常发生于脑外伤康复阶段,特别是并发蛛网膜下腔出血、伤后24 h内手术治疗、病程2个月以上的患者更易发生。

关键词: 脑外伤, 脑积水, 康复单元, 危险因素

Abstract:

Objective To investigate the risk factors related to hydrocephalus following traumatic brain injury in neurosurgical rehabilitation unit.
Methods From January 1st, 2016 to December 31st, 2017, 176 patients with traumatic brain injury admitting to the Department of Neurosurgery of Beijing Bo'ai Hospital were selected. They were divided into hydrocephalus group and non-hydrocephalus group according to the admitting diagnosis, and analyzed the related factors with univariate analysis and Logistic multiple regression.
Results There were 46% patients with hydrocephalus. Traumatic subarachnoid hemorrhage (OR = 4.127, 95%CI 1.742~9.776), course of disease (OR = 3.377, 95%CI 2.281~5.000) and process of operation (OR = 2.265, 95%CI 1.076~4.770) were independent risk factors to hydrocephalus.
Conclusion Hydrocephalus often emerge after traumatic brain injury in the rehabilitation period, especially for those with subarachnoid hemorrhage, course of disease over two months and surgery within 24 hours after injury.

Key words: traumatic brain injury, hydrocephalus, rehabilitation unit, risk factors

胡安明,王宇,孙炜. 神经外科康复单元脑外伤后脑积水发生危险因素分析[J]. 《中国康复理论与实践》, 2020, 26(9): 1083-1088.

HU An-ming,WANG Yu,SUN Wei. Risk Factors Related to Hydrocephalus Following Traumatic Brain Injury in Neurosurgical Rehabilitation Unit[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(9): 1083-1088.

图/表 2

表1

表2

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相关因素	非脑积水组(n = 95)	脑积水组(n = 81)	χ²值	P值
性别			0.026	0.871
男	76	64
女	19	17
年龄(岁)			2.540	0.468
≤ 18	17	12
19~44	34	24
45~60	30	35
>60	14	10
地区			0.308	0.579
北京市	19	19
非北京市	76	62
致伤原因			–^a	0.475
交通事故	61	56
坠落伤	7	7
砸伤	11	4
摔伤	15	13
刀割伤	1	0
原因不明	0	1
并发其他系统损伤			0.739	0.390
无	69	54
有	26	27
创伤性蛛网膜下腔出血			3.331	0.068
无	47	29
有	48	52
受伤后手术时间(h)			16.354	0.001
未手术	38	11
< 24	49	60
24~48	6	5
> 48	2	5
伤后意识状态			2.957	0.228
清醒	13	9
意识模糊	3	0
昏迷	79	72
伤后病程			–^a	< 0.001
1~4周	39	7
4 < ~8周	35	16
8 < ~12周	9	19
12周< ~12个月	12	37
> 12个月	0	2
入院时意识状态			0.177	0.915
清醒	54	45
微意识状态	7	5
昏迷	34	31
脑损伤类型			–^a	0.039
弥漫性轴索损伤	5	1
脑挫裂伤	11	2
脑内血肿	6	3
硬膜外血肿	4	6
硬膜下血肿	6	10
脑干损伤	3	0
多种类型合并损伤	60	59
颅骨缺损			3.576	0.059
无	40	23
有	55	58
行气管切开			11.475	< 0.001
无	51	23
有	44	58
并发颅内感染			2.454	0.117
无	92	74
有	3	7

自变量	β	SE	Wald	P值	OR	95%CI
创伤性蛛网膜下腔出血	1.418	0.440	10.380	0.001	4.127	1.742~9.776
病程	1.217	0.200	36.926	< 0.001	3.377	2.281~5.000
受伤后手术时间	0.818	0.380	4.631	0.031	2.265	1.076~4.770
脑损伤类型	-0.509	0.441	1.331	0.249	0.601	0.253~1.427
颅骨缺损	0.630	0.535	1.386	0.239	1.877	0.658~5.353
行气管切开	0.617	0.400	2.376	0.123	1.852	0.846~4.057

神经外科康复单元脑外伤后脑积水发生危险因素分析

Risk Factors Related to Hydrocephalus Following Traumatic Brain Injury in Neurosurgical Rehabilitation Unit

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