早产继发脑室内出血与首次放置分流管后第一年脑脊液分流手术的关联。
Association of intraventricular hemorrhage secondary to prematurity with cerebrospinal fluid shunt surgery in the first year following initial shunt placement.
作者信息
Simon Tamara D, Whitlock Kathryn B, Riva-Cambrin Jay, Kestle John R W, Rosenfeld Margaret, Dean J Michael, Holubkov Richard, Langley Marcie, Mayer-Hamblett Nicole
机构信息
Department of Pediatrics, University of Washington/Seattle Children's Hospital, Seattle, Washington, USA.
出版信息
J Neurosurg Pediatr. 2012 Jan;9(1):54-63. doi: 10.3171/2011.10.PEDS11307.
OBJECT
The neurosurgical literature has conflicting findings regarding the association between indications for CSF shunt placement and subsequent shunt surgery. The object of this study was to identify baseline factors at the time of initial CSF shunt placement that are independently associated with subsequent surgery.
METHODS
This was a retrospective cohort study of children ages 0-18 years who underwent initial CSF shunt placement between January 1, 1997, and October 12, 2006, at a tertiary care children's hospital. The outcome of interest was CSF shunt surgery (either for revision or infection) within 12 months after initial placement. Associations between subsequent CSF shunt surgery and indication for the initial shunt, adjusting for patient age and surgeon factors at the time of initial placement, were estimated using multivariate logistic regression. Medical and surgical decisions, which varied according to surgeon, were examined separately in a univariate analysis.
RESULTS
Of the 554 children in the study cohort, 233 (42%) underwent subsequent CSF shunt surgery, either for revision (167 patients [30%]) or infection (66 patients [12%]). In multivariate logistic regression modeling, significant risk factors for subsequent CSF shunt surgery included (compared with aqueductal stenosis) intraventricular hemorrhage (IVH) secondary to prematurity (adjusted odds ratio [AOR] 2.2, 95% CI 1.1-4.5) and other unusual indications (AOR 3.7, 95% CI 1.0-13.6). The patient's age at initial CSF shunt placement was not significantly associated with increased odds of subsequent surgery after adjusting for other associated factors.
CONCLUSIONS
The occurrence of IVH is associated with increased odds of subsequent CSF shunt surgery within 12 months after shunt placement. Families of and care providers for children with IVH should be attuned to their increased risk of shunt failure.
目的
神经外科文献对于脑脊液分流管置入指征与后续分流手术之间的关联存在相互矛盾的研究结果。本研究的目的是确定初次脑脊液分流管置入时与后续手术独立相关的基线因素。
方法
这是一项对1997年1月1日至2006年10月12日在一家三级儿童医院接受初次脑脊液分流管置入的0至18岁儿童进行的回顾性队列研究。感兴趣的结局是初次置入后12个月内的脑脊液分流手术（用于修复或感染）。使用多因素逻辑回归估计后续脑脊液分流手术与初次分流指征之间的关联，并对初次置入时的患者年龄和外科医生因素进行校正。根据外科医生的不同而有所变化的医疗和手术决策在单因素分析中分别进行研究。
结果
在研究队列的554名儿童中，233名（42%）接受了后续脑脊液分流手术，其中用于修复（167例患者[30%]）或感染（66例患者[12%]）。在多因素逻辑回归模型中，后续脑脊液分流手术的显著危险因素包括（与导水管狭窄相比）早产继发的脑室内出血（IVH）（校正比值比[AOR]为2.2，95%置信区间[CI]为1.1 - 4.5）和其他特殊指征（AOR为3.7，95% CI为1.0 - 13.6）。在对其他相关因素进行校正后，初次脑脊液分流管置入时患者的年龄与后续手术几率增加无显著关联。
结论
IVH的发生与分流管置入后12个月内后续脑脊液分流手术几率增加相关。IVH患儿的家庭和护理人员应注意其分流失败风险增加。
Zotero 插件