Guo Liemei, Chen Xu, Yu Bin, Shen Lin, Zhang Xiaohua
Department of Neurosurgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, District Pudong, Shanghai, China.
Department of Neurosurgery, Shangrao People's Hospital, Shangrao, Jiangxi Province, China.
World Neurosurg. 2017 Nov;107:160-167. doi: 10.1016/j.wneu.2017.07.133. Epub 2017 Jul 29.
Postoperative delayed intracerebral hemorrhage (DICH) secondary to ventriculoperitoneal (VP) shunt is a rare but severe event. The present study aimed to investigate the incidence and risk factors related to DICH after placement of the VP shunt.
The clinical data from 532 patients with VP shunt were collected retrospectively. All clinical variables were examined by univariate analysis, and a binary logistic regression analysis was performed to identify the risk factors related to DICH.
DICH occurred in 20 patients, from 3 to 10 days after placement of the VP shunt. Univariate analysis showed significant differences between the patients with DICH and without DICH with respect to age, history of hypertension, history of craniotomy, and features of the first computed tomography (CT) scans after placement of the VP shunt (all P < 0.05). The binary logistic regression analysis showed that age, history of craniotomy, and features of first CT scans after placement of the VP shunt were independent risk factors for DICH (all P < 0.05). The prognosis for patients with DICH was consistent with the hematoma volume and the neurologic status at the time of hospital admission (all P < 0.05).
DICH is a rare and potentially severe complication secondary to VP shunt, and a repeat of cranial CT scans after placement of the VP shunt is recommended. Advanced age, craniotomy history, and brain edema around the catheter on the first cranial CT scan after placement of the VP shunt served as independent risk factors for DICH. The patients with DICH with poor neurologic status at the time of hospital admission or large hematoma volume were associated with poor outcome.
脑室腹腔分流术（VP分流术）继发的术后迟发性脑出血（DICH）是一种罕见但严重的事件。本研究旨在调查VP分流术后DICH的发生率及相关危险因素。
回顾性收集532例行VP分流术患者的临床资料。对所有临床变量进行单因素分析，并进行二元逻辑回归分析以确定与DICH相关的危险因素。
20例患者发生DICH，发生在VP分流术后3至10天。单因素分析显示，发生DICH的患者与未发生DICH的患者在年龄、高血压病史、开颅手术史以及VP分流术后首次计算机断层扫描（CT）的特征方面存在显著差异（均P<0.05）。二元逻辑回归分析显示，年龄、开颅手术史以及VP分流术后首次CT扫描的特征是DICH的独立危险因素（均P<0.05）。DICH患者的预后与入院时的血肿体积和神经功能状态相关（均P<0.05）。
DICH是VP分流术继发的一种罕见且潜在严重的并发症，建议在VP分流术后复查头颅CT。高龄、开颅手术史以及VP分流术后首次头颅CT扫描时导管周围的脑水肿是DICH的独立危险因素。入院时神经功能状态差或血肿体积大的DICH患者预后不良。
