Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan.
Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, 123 University Road, Section 3, Douliou, Yunlin County, 640, Taiwan.
Neurocrit Care. 2018 Oct;29(2):233-240. doi: 10.1007/s12028-018-0532-x.
Spontaneous intracerebral hemorrhage is a disease with high morbidity and mortality. Extension of the hemorrhage into the ventricles is associated with the development of acute hydrocephalus and a poor outcome. Although it can be managed by external ventricular drainage (EVD), a subset of these patients require placement of permanent ventricular shunts. This study aimed to examine the factors on admission that can predict shunt dependency after EVD management.
Seventy-two patients who underwent EVD were included in this study. Seventeen of these patients underwent placement of a ventriculoperitoneal shunt. Variables analyzed included age, intraventricular hemorrhage (IVH) score, bicaudate index, acute hydrocephalus, initial Glasgow Coma Scale scores, and blood volume in each ventricle.
In univariate analysis, IVH score (p = 0.020), bicaudate index (p < 0.001), blood volume in lateral ventricles (p = 0.025), blood volume in the fourth ventricle (p = 0.038), and the ratio of blood volume in lateral ventricles to that in third and fourth ventricles (p = 0.003) were significantly associated with persistent hydrocephalus. The best multiple logistic regression model included blood volume parameters and bicaudate index as predictors with the area under a receiver operating characteristic curve of 0.849. The variance inflation factor (VIF) showed that collinearity was not found among predictors. Patients diagnosed with acute hydrocephalus had less blood volume in the lateral ventricles (OR = 0.910) and had more blood volume in the third ventricle (OR = 3.174) and fourth ventricle (OR = 2.126).
These findings may promote more aggressive monitoring and earlier interventions for persistent hydrocephalus after intraventricular hemorrhage in patients at risk.
自发性脑出血是一种发病率和死亡率都很高的疾病。出血延伸至脑室会导致急性脑积水的发展和不良预后。尽管可以通过外部脑室引流（EVD）进行治疗，但其中一部分患者需要放置永久性脑室分流管。本研究旨在探讨 EVD 治疗后预测分流依赖的入院因素。
本研究纳入了 72 例行 EVD 的患者。其中 17 例患者行脑室-腹腔分流术。分析的变量包括年龄、脑室内出血（IVH）评分、双尾指数、急性脑积水、初始格拉斯哥昏迷量表评分以及每个脑室的血容量。
在单因素分析中，IVH 评分（p=0.020）、双尾指数（p<0.001）、侧脑室血容量（p=0.025）、第四脑室血容量（p=0.038）以及侧脑室与第三、第四脑室血容量比值（p=0.003）与持续性脑积水显著相关。最佳多元逻辑回归模型包括血容量参数和双尾指数作为预测因子，受试者工作特征曲线下面积为 0.849。方差膨胀因子（VIF）表明预测因子之间没有发现共线性。诊断为急性脑积水的患者侧脑室血容量较少（OR=0.910），第三脑室和第四脑室血容量较多（OR=3.174 和 OR=2.126）。
这些发现可能会促进对有风险的脑室内出血患者进行更积极的监测和更早的干预，以预防持续性脑积水。
