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首页> 外文期刊>British journal of neurosurgery >Predictors for delayed ventriculoperitoneal shunt placement after external ventricular drain removal in patients with subarachnoid hemorrhage
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Predictors for delayed ventriculoperitoneal shunt placement after external ventricular drain removal in patients with subarachnoid hemorrhage

机译：蛛网膜下腔出血患者外引流后脑室-腹膜分流延迟放置的预测因素

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Objective. Hydrocephalus after subarachnoid hemorrhage (SAH) requires temporary cerebrospinal fluid (CSF) drainage using an external ventricular drain (EVD). This drain is removed if patients pass a clamp trial, or a ventriculoperitoneal shunt (VPS) is placed. Little is known about the risk factors for delayed VPS placement in patients who pass a clamp trial and have their EVD removed. In order to explore the risk factors associated with delayed VPS placement, we studied a retrospective cohort of SAH patients at our institution. Methods. We performed a retrospective analysis of SAH patients who had an EVD placed between January 2008 and June 2012 at our institution. We extracted demographic, imaging, and CSF data from the medical record and analyzed risk factors associated with delayed VPS placement. Results. Of 91 patients who passed a clamp trial and had their EVD removed, 12(13%) required delayed VPS placement at a median of 54 (interquartile range: 15-75) days after EVD removal. After multivariate analysis, risk factors for delayed VPS placement included increased CSF protein concentration within the first 7 days of EVD placement (OR: 1.02, CI: 1-1.04, p = 0.023) and increased third ventricular diameter prior to EVD removal (OR: 1.59, CI: 1.11-2.6, p = 0.026). Conclusion. Patients with increased CSF protein concentration at time of EVD placement and those with increased third ventricular diameter at time of EVD removal should be carefully monitored for development of delayed hydrocephalus.
机译：目的。蛛网膜下腔出血（SAH）后的脑积水需要使用外部心室引流（EVD）暂时性脑脊液（CSF）引流。如果患者通过了钳夹试验，或者放置了腹膜-腹膜分流（VPS），则可以消除这种引流。通过钳夹试验并移除EVD的患者中，延迟VPS放置的危险因素知之甚少。为了探讨与延迟VPS放置相关的危险因素，我们在我们机构研究了SAH患者的回顾性队列。方法。我们对2008年1月至2012年6月在我们机构接受EVD的SAH患者进行了回顾性分析。我们从病历中提取了人口统计学，影像学和CSF数据，并分析了与延迟VPS放置相关的危险因素。结果。在通过钳夹试验并移除EVD的91位患者中，有12位（13％）要求在EVD移除后的中位数54天（四分位间距：15-75）天延迟放置VPS。经过多变量分析后，延迟VPS放置的风险因素包括在EVD放置的前7天内CSF蛋白浓度增加（OR：1.02，CI：1-1.04，p = 0.023），以及在EVD去除前第三心室直径增加（OR： 1.59，CI：1.11-2.6，p ＝ 0.026）。结论。接受EVD时CSF蛋白浓度升高的患者和移除EVD时第三心室直径增加的患者，应仔细监测其迟发性脑积水的发生。

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