动脉瘤术后分流依赖性脑积水的危险因素分析
段佩 蔡远坤 杨超 邵钰阳 江普查△
武汉大学中南医院，湖北 武汉 430071
作者简介：段佩，Email：18771056853@163.com
△通信作者：江普查，Email：jiangpucha64@163.com
【摘要】 目的 筛选动脉瘤术后发生分流依赖性脑积水(shunt-dependent hydrocephalus，SDH)的危险因素，为动脉瘤术后SDH 临床治疗提供指导意见。方法 回顾性分析2019-01—2019-12 在中南医院神经外科接受治疗的246 例动脉瘤手术患者的相关临床资料，按是否并发SDH 分为SDH 组(27 例)和非SDH 组(219 例)，对 2 组患者的临床相关资料行单因素分析，并将有显著性差异的结果纳入多因素 logistic 回归分析，探讨发生 SDH 的危险因素。结果 单因素分析显示，入院 GCS 评分、Hunt-Hess 分级、改良 Fisher 分级、持续脑脊液引流、动脉瘤破裂、术前急性脑积水、动脉瘤的部位、动脉瘤的大小及去骨瓣减压与 SDH 的发生密切相关(P＜0.05)。多因素logistic 回归分析显示，持续脑脊液引流(OR=3.928，95% CI：1.235~12.496)、 Hunt-Hess 分级(Ⅲ ~ Ⅴ级)(OR=6.034，95% CI：1.349~26.988)、动脉瘤部位(后循环)(OR=0.317，95% CI： 0.103~0.976)是动脉瘤术后发生SDH 的独立危险因素(P＜0.05)。结论 SDH 是动脉瘤术后常见的严重并发症，其危险因素包括持续脑脊液引流、高 Hunt-Hess 分级(Ⅲ~Ⅴ级)、后循环动脉瘤。合并这些危险因素的病人应特别关注，可针对不同病人采取个体化措施减少术后分流依赖性脑积水的发生。
【关键词】 脑积水；动脉瘤；分流依赖；危险因素
【中图分类号】 R742.7 【文献标识码】 A 【文章编号】 1673-5110 (2021) 24-2117-09
Analysis of risk factors for shunt-dependent hydrocephalus after aneurysm surgery
【Abstract】 Objective To screen the risk factors of shunt-dependent hydrocephalus(SDH)after aneurysm surgery，and provide guidance for the clinical treatment of SDH after aneurysm surgery. Methods The relevant clinical data of 246 patients with aneurysm surgery who were treated in the Department of Neurosurgery of Zhong⁃ nan Hospital from January 2019 to December 2019 were retrospectively analyzed，and were divided into SDH group(27 cases)and non-SDH group(219 cases)according to whether there was concurrent SDH. The clinical data of the two groups of patients were analyzed by single factor analysis. The results with significant differences were included in multivariate logistic regression analysis to explore the risk factors of SDH. Results Univariate analysis results showed that，admission GCS score，Hunt-Hess classification，modified Fisher classification，continuous cerebrospinal fluid drainage，aneurysm rupture，preoperative acute hydrocephalus，aneurysm location，aneurysm size and bone reduction pressure were closely related to the occurrence of SDH(P<0.05). Multivariate logistic re⁃ gression analysis showed that，continuous cerebrospinal fluid drainage (OR=3.928，95% CI：1.235-12.496)， Hunt-Hess grade (grade)(OR=6.034，95% CI：1.349-26.988)，aneurysm Location (posterior circulation)(OR= 0.317，95% CI：0.103-0.976) were independent risk factors for SDH after aneurysm surgery (P<0.05). Conclusion SDH is a common serious complication after aneurysm surgery，and its risk factors include continuous cerebrospinal fluid drainage，high Hunt-Hess grade(Ⅲ-Ⅴ)，and posterior circulation aneurysm. Patients with these risk factors should be paid special attention，and individualized measures should be taken for different patients to reduce the occurrence of shunt-dependent hydrocephalus after surgery.
【Key words】 Hydrocephalus；Aneurysm；Shunt dependence；Risk factors