Li Hao,Chen Zhaohui,Fan Shuangshi,et al.Outcomes after initial Ommaya reservoir implantation for posthemorrhagic hydrocephalus secondary to neonatal intracranial hemorrhage and associated factors[J].Journal of Clinical Pediatric Surgery,2026,(02):118-123.[doi:10.3760/cma.j.cn101785-101785-20251021-00010]
新生儿颅内出血继发脑积水首次Ommaya囊植入术后效果及相关因素分析
- Title:
- Outcomes after initial Ommaya reservoir implantation for posthemorrhagic hydrocephalus secondary to neonatal intracranial hemorrhage and associated factors
- Keywords:
- Intracranial Hemorrhage; Infant; Newborn; Hydrocephalus; Drainage; Prognosis; Risk Factors
- 摘要:
- 目的 探讨新生儿颅内出血继发脑积水(posthemorrhagic hydrocephalus,PHH)首次行Ommaya囊植入术后预后不良的危险因素,为临床治疗及预后评估提供依据。方法 回顾性分析2020年6月至2025年3月在中南大学湘雅医学院附属儿童医院(湖南省儿童医院)神经外科首次行Ommaya囊植入术的39例PHH患儿临床资料,根据术后6个月PHH 改善情况分为预后良好组(25例)和预后较差组(14例)。收集两组患儿手术时日龄、体重、性别、ASA分级、Papile分级、脑室积血、硬膜下出血及蛛网膜下腔出血情况等。采用单因素分析及二元Logistic回归模型筛选预后不良危险因素。结果 预后良好组中,Papile分级Ⅰ级2例(8%,2/25)、Ⅱ级9例(36%,9/25)、Ⅲ级14例(56%,14/25);预后较差组中,Papile分级Ⅱ级2例(14.29%,2/14)、Ⅲ级5例(35.71%,5/14)、Ⅳ级7例(50%,7/14)。预后较差组患儿Papile分级显著高于预后良好组,差异有统计学意义(P=0.001)。两组手术时日龄、体重、性别、ASA分级、脑室积血、硬膜下出血及蛛网膜下腔出血等差异无统计学意义(P>0.05)。二元Logistic回归分析表明,高Papile分级是新生儿颅内出血继发PHH行Ommaya囊植入术后预后不良的独立危险因素(B=2.080,SE=0.749,Wald χ2=7.711,P=0.005,OR=8.008,95%CI:1.844~34.753)。结论 高Papile分级可增加新生儿颅内出血后PHH行Ommaya囊植入术后预后不良的风险,建议针对高Papile分级患儿加强围手术期管理和长期随访。
- Abstract:
- Objective To explore the risk factors for poor prognosis after initial Ommaya reservoir implantation in neonates with posthemorrhagic hydrocephalus (PHH) secondary to intracranial hemorrhage,and to provide evidence for clinical management and prognostic evaluation. Methods A retrospective analysis was conducted on the clinical data of 39 neonates with PHH who underwent initial Ommaya reservoir implantation in the Department of Neurosurgery,Children’s Hospital Affiliated to Xiangya School of Medicine,Central South University (Hunan Children’s Hospital) between June 2020 and March 2025.According to the improvement of PHH at 6 months after surgery,patients were divided into a good prognosis group (n=25) and a poor prognosis group (n=14).Data collected included age at surgery,body weight,gender,ASA classification,Papile grade,intraventricular hemorrhage,subdural hemorrhage,and subarachnoid hemorrhage.Univariate analysis and binary logistic regression were used to identify risk factors for poor prognosis. Results In the good prognosis group,Papile grade Ⅰ was observed in 2 cases (8%,2/25),grade Ⅱ in 9 cases (36%,9/25),and grade Ⅲ in 14 cases (56%,14/25).In the poor prognosis group,Papile grade Ⅱ was observed in 2 cases (14.29%,2/14),grade Ⅲ in 5 cases (35.71%,5/14),and grade Ⅳ in 7 cases (50%,7/14).The Papile grade in the poor prognosis group was significantly higher than that in the good prognosis group,with a statistically significant difference (P=0.001).There were no significant differences between the two groups in age at surgery,body weight,gender,ASA classification,intraventricular hemorrhage,subdural hemorrhage,or subarachnoid hemorrhage (P>0.05).Binary logistic regression analysis showed that a higher Papile grade was an independent risk factor for poor prognosis after Ommaya reservoir implantation in neonates with PHH secondary to intracranial hemorrhage (B=2.080,SE=0.749,Wald=7.711,P=0.005,OR=8.008,95%CI:1.844-34.753). Conclusions A higher Papile grade increases the risk of poor prognosis after Ommaya reservoir implantation in neonates with PHH secondary to intracranial hemorrhage.Enhanced perioperative management and long-term follow-up are recommended for patients with a high Papile grade.
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备注/Memo
收稿日期:2025-10-21。
基金项目:湖南省卫生健康科研课题(20255753)
通讯作者:吴水华,Email:292454021@qq.com