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首页> 外文期刊>Journal of neurosurgery. >Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus.
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Risk factors for repeated cerebrospinal shunt failures in pediatric patients with hydrocephalus.

机译：小儿脑积水患者反复发生脑脊髓分流失败的危险因素。

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OBJECT: Repeated cerebrospinal fluid (CSF) shunt failures in pediatric patients are common, and they are a significant cause of morbidity and, occasionally, of death. To date, the risk factors for repeated failure have not been established. By performing survival analysis for repeated events, the authors examined the effects of patient characteristics, shunt hardware, and surgical details in a large cohort of patients. METHODS: During a 10-year period all pediatric patients with hydrocephalus requiring CSF diversion procedures were included in a prospective single-institution observational study. Patient characteristics were defined as age, gender, weight, head circumference, American Society of Anesthesiology class, and cause of hydrocephalus. Surgical details included whether the procedure was performed on an emergency or nonemergency basis, use of antibiotic agents, concurrent surgical procedures, and duration of the surgical procedure. Details on shunt hardware included: the type of shunt, the valve system, whether the shunt system included multiple or complex components, the type of distal catheter, the site of the shunt, and the side on which the shunt was placed. Repeated shunt failures were assessed using multivariable time-to-event analysis (by using the Cox regression model). Conditional models (as established by Prentice, et al.) were formulated for gap times (that is, times between successive shunt failures). There were 1183 shunt failures in 839 patients. Failure time from the first shunt procedure was an important predictor for the second and third episodes of failure, thus establishing an association between the times to failure within individual patients. An age younger than 40 weeks gestation at the time of the first shunt implantation carried a hazard ratio (HR) of 2.49 (95% confidence interval [CI] 1.68-3.68) for the first failure, which remained high for subsequent episodes of failure. An age from 40 weeks gestation to 1 year (at the time of the initial surgery) also proved to be an important predictor of first shunt malfunctions (HR 1.77, 95% CI 1.29-2.44). The cause of hydrocephalus was significantly associated with the risk of initial failure and, to a lesser extent, later failures. Concurrent other surgical procedures were associated with an increased risk of failure. CONCLUSIONS: The patient's age at the time of initial shunt placement and the time interval since previous surgical revision are important predictors of repeated shunt failures in the multivariable model. Even after adjusting for age at first shunt insertion as well as the cause of hydrocephalus, there is significant association between repeated failure times for individual patients.
机译：目的：小儿患者反复发生脑脊液（CSF）分流失败的情况很普遍，是造成发病率和死亡的重要原因。迄今为止，尚未确定重复失败的风险因素。通过对重复事件进行生存分析，作者检查了大批患者中患者特征，分流硬件和手术细节的影响。方法：在10年期间，所有需要脑脊液转移手术的小儿脑积水患者均纳入前瞻性单机构观察性研究。患者特征定义为年龄，性别，体重，头围，美国麻醉学会等级以及脑积水的原因。手术细节包括手术是在紧急情况下进行还是在非紧急情况下进行，使用抗生素，同时进行的手术程序和手术时间长短。分流器硬件的详细信息包括：分流器的类型，阀系统，分流器系统是否包含多个组件或复杂的组件，远端导管的类型，分流器的位置以及放置分流器的一侧。使用多变量事件发生时间分析（通过使用Cox回归模型）评估重复的分流失败。为间隙时间（即连续分流器故障之间的时间）制定了条件模型（由Prentice等建立）。 839名患者中有1183次分流失败。第一次分流手术的失败时间是第二次和第三次失败的重要预测指标，因此在各个患者的失败时间之间建立了联系。第一次分流植入时，年龄小于40周的胎龄，首次失败的危险比（HR）为2.49（95％置信区间[CI] 1.68-3.68），对于随后的失败发作仍然很高。妊娠40周至1岁（首次手术时）的年龄也被证明是首次分流功能故障的重要预测指标（HR 1.77，95％CI 1.29-2.44）。脑积水的原因与最初失败的风险显着相关，在较小程度上则与后来的失败有关。同时进行其他外科手术会增加失败的风险。结论：在多变量模型中，初次分流放置时的患者年龄和自先前手术修订以来的时间间隔是反复分流失败的重要预测指标。即使在首次分流插入时调整了年龄以及脑积水的原因之后，各个患者的重复失败时间之间也存在显着关联。

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