Objective To investigate the risk factors of intra-operative acute encephalocele in traumatic brain injury patients undergoing craniotomy.Methods A total of 64 traumatic brain injury patients undergoing craniotomy were selected in Dalang Hospital of Dongguan from January 2014 to January 2016,and they were divided into A group (complicated with acute encephalocele,n =14) and B group (did not complicate with acute encephalocele,n =50) according to the incidence of intra -operative acute encephalocele.Clinical data was retrospectively analyzed,all-cause mortality and incidence of sequelae during the 1-year follow-up were compared between the two groups,and influencing factors of intra-operative acute encephalocele in traumatic brain injury patients undergoing craniotomy were analyzed by multivariate Logistic regression analysis.Results There were statistically significant differences of age,history of hypertension,taking history of anticoagulant drugs,incidence of contralateral skull fracture,preoperative body temperature,preoperative intracranial pressure,preoperative GCS score,PLT and PT between the two groups (P ＜ 0.05),while no statistically significant differences of gender,injury types,history of diabetes,smoking history or duration between being injury and craniotomy was found between the two groups (P ＞ 0.05).All-cause mortality and incidence of sequelae of A group were statistically significantly higher than those of B group during the 1-year follow-up (P ＜ 0.05).Multivariate Logistic regression analysis results showed that,taking history of anticoagulant drugs [OR =2.36,95％ CI (1.77,3.42)],contralateral skull fracture [OR =2.56,95％ CI (1.95,3.35)],preoperative body temperature [OR =1.67,95％ CI (1.04,2.66)],preoperative intracranial pressure [OR =4.26,95％ CI (1.70,10.70)] and preoperative GCS score [OR =8.33,95％ CI (4.35,15.96)] were risk factors of intra-operative acute encephalocele in traumatic brain injury patients undergoing craniotomy (P ＜ 0.05).Conclusion All-cause mortality and incidence of sequelae are significantly higher in traumatic brain injury patients (undergoing craniotomy) complicated with intra-operative acute encephalocele,meanwhile taking history of anticoagulant drugs,contralateral skull fracture,preoperative body temperature,preoperative intracranial pressure and preoperative GCS score are risk factors of intra-operative acute encephalocele in traumatic brain injury patients undergoing craniotomy.%目的 探讨创伤性颅脑损伤(TBI)患者开颅术中急性脑膨出的危险因素.方法 选取2014年1月-2016年1月在东莞市大朗医院行开颅手术的TBI患者64例,根据开颅术中是否发生急性脑膨出分为膨出组14例和未膨出组50例.回顾性分析所有患者的临床资料;随访1年,比较两组患者全因死亡率和后遗症发生率;TBI患者开颅术中急性脑膨出的影响因素分析采用多因素Logistic回归分析.结果 两组患者年龄、高血压病史、抗凝药物服用史、对侧颅骨骨折发生率、术前体温、术前颅内压、术前格拉斯哥昏迷量表(GCS)评分、血小板计数(PLT)及凝血酶原时间(PT)比较,差异均有统计学意义(P＜0.05);两组患者性别、损伤类型、糖尿病病史、吸烟史、受伤至手术时间比较,差异均无统计学意义(P＞0.05).随访1年,膨出组患者全因死亡率和后遗症发生率高于未膨出组(P＜0.05).多因素Logistic回归分析结果显示,抗凝药物服用史[OR=2.36,95％CI (1.77,3.42)]、对侧颅骨骨折[OR =2.56,95％CI (1.95,3.35)]、术前体温[OR=1.67,95％CI (1.04,2.66)]、术前颅内压[OR =4.26,95％CI (1.70,10.70)]和术前GCS评分[OR =8.33,95％ CI (4.35,15.96)]是TBI患者开颅术中急性脑膨出的危险因素(P＜0.05).结论 开颅术中发生急性脑膨出的TBI患者全因死亡率和后遗症发生率较高,而抗凝药物服用史、对侧颅骨骨折、术前体温、术前颅内压及术前GCS评分是TBI患者开颅术中急性脑膨出的危险因素.
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