摘要：
目的: 筛查脑积水患者腰大池-腹腔分流术后短期神经功能预后的影响因素。方法: 纳入2014年10月至2020年1月在首都医科大学宣武医院行腰大池-腹腔分流术的136例脑积水患者，出院时采用改良Rankin量表（mRS）评价脑积水术后短期神经功能预后，单因素和多因素Logistic回归分析筛查术后短期神经功能预后不良的影响因素。结果: 共136例患者根据出院时mRS评分分为预后良好（mRS评分≤3分）组（65例）和预后不良（mRS评分>3分）组（71例），Logistic回归分析，入院时Glasgow昏迷量表（GCS）评分9 ~ 12分（OR=7.800，95%CI：7.205 ~ 8.443；P=0.000）和3 ~ 8分（OR=6.299，95%CI：5.744 ~ 6.907；P=0.006），病因为颅脑创伤（OR=27.681，95%CI：24.270 ~ 31.572；P=0.000）、脑出血（OR=13.017，95%CI：11.473 ~ 14.769；P=0.005）、蛛网膜下腔出血（OR=17.682，95%CI：15.683 ~ 19.935；P=0.001）和其他原因（OR=5.851，95%CI：5.166 ~ 6.628；P=0.050）是脑积水患者腰大池-腹腔分流术后短期神经功能预后不良的危险因素。结论: 脑积水患者腰大池-腹腔分流术后神经功能预后受多种因素影响，不同入院时GCS评分、不同病因患者预后不同，应根据具体情况制定个性化治疗方案。
关键词:
脑积水,
脑脊髓液分流术,
预后,
危险因素,
Logistic模型
Abstract:
Objective: To screen factors influencing the neurological prognosis following lumboperitoneal shunt (LPS) in patients with hydrocephalus. Methods: Total 136 patients who underwent LPS in Xuanwu Hospital, Capital Medical University from October 2014 to January 2020. The short-term neurological prognosis post-surgery were evaluated by modified Rankin Scale (mRS) at discharge. Univariate and multivariate stepwise Logistic regression analyses were conducted to screen factors affecting neurological prognosis. Results: Of the 136 patients, 65 were categorized into the good prognosis group (mRS score ≤ 3), and 71 into the poor prognosis group (mRS score > 3). Logistic regression analysis indicated that an admission Glasgow Coma Scale (GCS) score of 9-12 (OR=7.800, 95%CI: 7.205-8.443; P=0.000) and 3-8 (OR=6.299, 95%CI: 5.744-6.907; P=0.006), as well as etiologies including traumatic brain injury (OR=27.681, 95%CI: 24.270-31.572; P=0.000), cerebral hemorrhage (OR=13.017, 95%CI: 11.473-14.769; P=0.005), subarachnoid hemorrhage (OR=17.682, 95%CI: 15.683-19.935; P=0.001), and other causes (OR=5.851, 95%CI: 5.166-6.628; P=0.050) were risk factors for poor short-term neurological prognosis in patients with hydrocephalus undergoing LPS. Conclusions: The neurological prognosis after LPS in patients with hydrocephalus is influenced by multiple factors. Prognoses vary among patients with different admission GCS scores and different etiologies. Personalized treatment plans should be developed based on specific circumstances.
Key words:
Hydrocephalus,
Cerebrospinal fluid shunts,
Prognosis,
Risk factors,
Logistic models
赵浩, 曲鑫, 王宁, 尚峰, 徐跃峤, 齐猛. 脑积水腰大池-腹腔分流术预后影响因素分析[J]. 中国现代神经疾病杂志, 2024, 24(6): 450-454.
Hao ZHAO, Xin QU, Ning WANG, Feng SHANG, Yue-qiao XU, Meng QI. Analysis of factors affecting the efficacy of lumboperitoneal shunt in the treatment of hydrocephalus[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2024, 24(6): 450-454.