摘要
目的分析脑室积血行脑室外引流术后拔管困难的相关因素。方法选取脑出血后脑室积血并行脑室穿刺外引流术的206例患者为研究对象,将其中142例患者根据术后7 d拔管情况分为正常拔管组(n=78)和拔管困难组(n=64)。比较2组心率、舒张压、收缩压、平均动脉压、颅内压变化情况、术后平均拔管时间、术后平均住院时间以及并发症发生情况;分析脑室积血行脑室外引流术后拔管困难的影响因素,并采用多因素Logistic回归分析找出拔管困难的危险因素。将其余64例脑出血后脑室积血并行脑室穿刺外引流术的患者作为干预组,将拔管困难组患者作为对照,其中干预组对危险因素实施干预措施,拔管困难组不实施任何干预措施,比较干预组和拔管困难组的平均住院时间、术后平均拔管时间、格拉斯哥昏迷量表(GCS)评分、格拉斯哥预后量表(GOS)评分及并发症发生率。结果正常拔管组修订Graeb评分、心率、舒张压、收缩压、平均动脉压、颅内压均低于拔管困难组,而GCS评分高于拔管困难组,差异有统计学意义(P<0.05)。Logistic回归分析显示,颅内压升高、脑脊液循环障碍、CT检查存在血肿、引流不畅是脑室积血行脑室外引流术后拔管困难的独立危险因素(P<0.05)。干预后,干预组术后平均住院时间、术后平均拔管时间短于拔管困难组,GCS、GOS评分均高于拔管困难组,差异有统计学意义(P<0.05);干预组并发症发生率低于拔管困难组,但差异无统计学意义(P>0.05)。结论颅内压升高、脑脊液循环障碍、引流不畅、CT检查存在血肿是脑室积血行脑室外引流术后拔管困难的独立危险因素。临床进行针对性预防治疗可有效缩短引流时间和住院时间,降低颅内感染、脑积水和再出血等并发症发生率,改善预后。
Objective To analyze related factors of difficult extubation after external ventricular drainage in patients with ventricular hemorrhage.Methods A total of 206 patients with intraventricular hemorrhage undergoing ventricular puncture and external drainage were selected,and 142 of 206 patients were divided into normal extubation group(n=78)and difficult extubation group(n=64)according to conditions of tubes removal at 7 days after operation.The heart rate,diastolic blood pressure,systolic blood pressure,mean arterial pressure,intracranial pressure changes,average postoperative extubation time,postoperative average hospital stay,and occurrence of complications of two groups were compared;the influencing factors of difficult extubation after external ventricular drainage in treating intraventricular hemorrhage were analyzed,and multivariate Logistic regression analysis was used to find out the risk factors of difficult extubation.The rest of 64 patients with intraventricular hemorrhage caused by cerebral hemorrhage undergoing ventricular puncture and external drainage were selected as intervention group,and those in the difficult extubation group were as controls.The intervention group implemented intervention measures for risk factors,and the difficult extubation group implemented no intervention measures.The average hospital stay,average postoperative time of extubation,Glasgow Coma Scale(GCS)score,Glasgow Outcome Scale(GOS)score,and complication rate were compared between the intervention group and the difficult extubation group.Results The revised Graeb score,heart rate,diastolic blood pressure,systolic blood pressure,mean arterial pressure,and intracranial pressure in the normal extubation group were significantly lower,while the GCS score was significantly higher than that in the difficult extubation group(P<0.05).Logistic regression analysis showed that the increase in intracranial pressure,cerebrospinal fluid circulation disorder,the presence of hematoma by CT examination,and poor drainage were independent risk factors of difficult extubation for intraventricular hemorrhage undergoing ventricular puncture and external drainage(P<0.05).The average postoperative hospital stay and the average postoperative extubation time of the intervention group were shorter than those of the difficult extubation group,and the GCS and GOS scores were higher than those of the difficult extubation group,the differences were statistically significant(P<0.05);the incidence of complications in the intervention group was lower than that in the difficult extubation group,but the difference was not statistically significant(P>0.05).Conclusion Elevated intracranial pressure,cerebrospinal fluid circulation disorder,poor drainage and the presence of hematoma by CT examination are independent risk factors for difficult extubation after extraventricular drainage in treating ventricular hemorrhage.Targeted clinical preventive treatment can effectively shorten drainage time and hospitalization time,reduce the incidence rates of complications such as intracranial infection,hydrocephalus,and re-bleeding,and improve the prognosis.
作者
李文贵
肖芳
LI Wengui;XIAO Fang(Department of Neurosurgery,People′s Hospital of Huichang County in Jiangxi Province,Ganzhou,Jiangxi,342600;Department of Obstetrics and Gynecology,People′s Hospital of Huichang County in Jiangxi Province,Ganzhou,Jiangxi,342600)
出处
《实用临床医药杂志》
CAS
2020年第21期64-68,共5页
Journal of Clinical Medicine in Practice
基金
江西省赣州市科技局指导科技计划项目(GZ2019ZSF525)。
关键词
脑室出血
脑室外引流术
拔管困难
危险因素
颅内感染
intraventricular hemorrhage
extraventricular drainage
difficult extubation
risk factors
intracranial infection
