Risk Factors for Conversion to Permanent Ventricular Shunt in Patients Receiving Therapeutic Ventriculostomy for Traumatic Brain Injury
Risk Factors for Conversion to Permanent Ventricular Shunt in Patients Receiving Therapeutic Ventriculostomy for Traumatic Brain Injury
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DOI：
10.1227/neu.0b013e3181fd85f4
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发表时间：
2011-01-01
期刊：
影响因子：
4.8
通讯作者：
Markert, James M.
中科院分区：
文献类型：
--
作者：
Bauer, David F.;McGwin, Gerald, Jr.;Markert, James M.
背景：颅内压是严重创伤性脑损伤（TBI）患者的常规监测指标。TBI患者有时会出现脑积水，需要永久性脑脊液（CSF）分流术。目的：量化TBI患者永久性CSF分流术的需求。方法：确定2007年6月至2008年7月期间TBI后接受脑室造口术的患者，并将其病历提取到数据库中。结果：接受脑室造口术的71例患者中有16例（22.5%）在出院前需要进行脑室腹膜或脑室心房分流术。脑室造口术和分流术之间的平均天数为18.3天。使这些患者倾向于需要永久性CSF分流的特征包括入院后48小时内需要开颅手术（比值比，5.20; 95%置信区间，1.48-18.35）和CSF培养阳性史（比值比，5.52; 95%置信区间，1.19-25.52）。接受永久性脑脊液分流术的患者的住院时间延长（平均住院时间，61 vs 31天; P = 0.04）。分流和nonshunted patients.CONCLUSION：在这项回顾性研究中，22%的TBI患者谁需要脑室造口术最终需要永久性脑脊液分流之间的患者出院处置是相似的。TBI患者出院前应评估是否需要永久性CSF分流。必须注意预防脑室炎。需要进一步的研究来更彻底地评价该患者人群中需要永久性CSF分流的风险因素。
BACKGROUND: Intracranial pressure is routinely monitored in patients with severe traumatic brain injury (TBI). Patients with TBI sometimes develop hydrocephalus, requiring permanent cerebrospinal fluid (CSF) diversion.OBJECTIVE: To quantify the need for permanent CSF diversion in patients with TBI.METHODS: Patients who received a ventriculostomy after TBI between June 2007 and July 2008 were identified, and their medical records were abstracted to a database.RESULTS: Sixteen of 71 patients (22.5%) receiving a ventriculostomy required a ventriculoperitoneal or ventriculoatrial shunt before discharge from the hospital. The average number of days between ventriculostomy and shunt was 18.3. Characteristics that predispose these patients to require permanent CSF diversion include the need for craniotomy within 48 hours of admission (odds ratio, 5.20; 95% confidence interval, 1.48-18.35) and history of culture-positive CSF (odds ratio, 5.52; 95% confidence interval, 1.19-25.52). Length of stay was increased in patients receiving permanent CSF diversion (average length of stay, 61 vs 31 days; P = .04). Patient discharge disposition was similar between shunted and nonshunted patients.CONCLUSION: In this retrospective study, 22% of TBI patients who required a ventriculostomy eventually needed permanent CSF diversion. Patients with TBI should be assessed for the need for permanent CSF diversion before discharge from the hospital. Care must be taken to prevent ventriculitis. Future studies are needed to evaluate more thoroughly the risk factors for the need for permanent CSF diversion in this patient population.