脑室内出血后脑积水形成的多因素分析被引量：6

Analysis of influencing factors for hydrocephalus after intraventricular hemorrhage

导出

摘要目的探讨影响脑室出血后脑积水形成的相关因素,为临床防治提供理论依据。方法对收治的符合条件的120例脑室出血患者进行回顾性研究,分为脑积水组(27例)和非脑积水组(93例)。对年龄、性别、糖尿病史、高血压病史、出血时格拉斯哥昏迷评分(GCS)、修正Graeb评分(m GS)、脑室积血量、脑室内反复出血次数、行侧脑室外引流、侧脑室联合腰大池外引流与脑积水之间的关系进行单因素和Logistic逐步回归法多因素分析。结果 120例脑室出血的患者发生脑积水27例,发生率为22.5%。单因素分析结果显示:年龄、高血压病史、出血时GCS评分、m GS评分、脑室积血量、脑室内反复出血次数、侧脑室外引流和侧脑室联合腰大池外引流与脑室出血后脑积水有关;而性别、糖尿病史与脑室出血后脑积水的发生无明显相关性(P>0.05)。多因素Logistic回归法分析表明,年龄(OR=1.078,95%CI:1.029~1.130)、高血压病史(OR=1.622,95%CI:0.200~13.167)、出血时GCS评分(OR=0.730,95%CI:0.596~0.894)、m GS评分(OR=1.883,95%CI:1.315~2.695)、脑室积血量(OR=1.052,95%CI:1.011~1.096)、脑室内反复出血次数(OR=1.305,95%CI:0.626~2.717)、侧脑室外引流(OR=0.045,95%CI:0.011~0.175)和侧脑室联合腰大池外引流(OR=0.723,95%CI:0.591~0.884)为影响脑脊液发生的相关因素,其中GCS评分越高、侧脑室外引流及侧脑室联合腰大池外引流为保护性因素。结论年龄增大、高血压病史、m GS评分越高、脑室内复出血次数、脑室积血量大为脑室出血后脑积水产生的危险因素,而脑室内出血时GCS评分越高,同时积极行侧脑室外引流及侧脑室联合腰大池外引流可明显降低脑室出血后脑积水的形成。 Objective To investigate the influencing factors for hydrocephalus in patients with intraventricular hemorrhage（IVH） and provide the theoretical basis for clinical work. Methods Retrospective study was carried on 120 patients with intraventricular hemorrhage, and they were divided into two groups： hydrocephalus group （27 cases ） and non-hydrocephalus group （93 cases）. Age, gender, history of diabetes mellitus, history of hypertension, bleeding Glasgow coma scale （GCS） score, the modified Graeb （mGS） score, intraventricular hematocele, intraventricular bleeding times, external ventricular drainage, external ventricular drainage combined with lumbar cistern drainage of cerebrospinal fluid were studied to determine the relationship between the related factors and hydrocephalus. Multiple factor analysis was done with Logistic regression. Results Of 120 patients with intraventricular hemorrhage, 27 （22.5%）occurred in hydrocephalus. Univariate analysis showed that： age, history of hypertension, bleeding GCS score, raGS score, intraventricular hematocele, intraventricular bleeding times, external ventricular drainage, external ventricular drainage combined with lumbar cistern drainage of cerebrospinal fluid related hydrocephalus after intraventricular hemorrhage;and gender,history of diabetes mellitus and the incidence of hydrocephalus after intraventricular hemorrhage had no significant correlation（ P 〉 0.05 ）. Multivariate Logistic regression analysis showed that ： age （ OR = 1. 078,95% CI：1. 029-1. 130 ）, history of hypertension （ OR = 1. 622,95% CI：0. 200-13.167） ,bleeding GCS score（ OR =0. 730,95% CI：0. 596-0. 894） ,mGS score（ OR = 1. 883,95% CI： 1. 315-2. 695 ）, intraventricular hematocele （ OR = 1. 052, 95% CI： 1. 011-1. 096 ）, intraventricular bleeding times （ OR = 1. 305,95% CI： 0. 626-2.717 ）, external ventricular drainage （ OR = 0. 045,95% CI： 0. 011-0. 175）, external ventricular drainage combined with lumbar cistern drainage of cerebrospinal fluid （ OR = 0. 723,95% CI： 0. 591-0. 884 ） were screened out as the influencing factors for hydrocephalus after intraventricular hemorrhage. External ventrieular drainage, external ventricular drainage combined with lumbar cistern drainage of eerebraspinal fluid were the protective factors. Cond^ion Age, history of hypertension, mGS score,intraventrieular hematocele,intraventricular bleeding times are influencing factors for the forming of hydrocephalus after intraventrieular hemorrhage. External ventricular drainage combined with lumbar cistern drainage of cerebrospinal fluid can greatly reduce the incidence of hydrocephalus after intraventrieular hemorrhage.

作者袁强周志龙步星耀孙彦熙闫兆月马春晓屈鸣麒张慧

机构地区郑州大学人民医院神经外科

出处《中华脑科疾病与康复杂志（电子版）》 2015年第1期5-9,共5页 Chinese Journal of Brain Diseases and Rehabilitation（Electronic Edition）

基金河南省科技发展计划基金资助项目(132300410366)

关键词脑积水脑室出血脑室外引流腰大池外引流 Hydrocephalus Intraventricular hemorrhage External ventricular drainage Lumbar cistern drainage

分类号 R651.1 [医药卫生—外科学]

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