微创术治疗幕上自发性脑出血的预后判别分析

Discriminant analysis affecting prognosis of patients with spontaneous supratentorial cerebral hemorrhage after minimally invasive operation

目的探讨影响自发性幕上脑出血患者微创术治疗预后的危险因素,建立微创术治疗脑出血术后30d内预后的判别模型。方法回顾性分析97例经微创术治疗的脑出血患者的临床资料,对影响微创术治疗预后的危险因素进行单因素和多元逐步判别分析。结果97例患者中,术后30d死亡27例(27.8%)。单因素分析表明:意识水平、出血量、出血半球、伴发缺血性心脏病和微创手术时间是影响其预后的危险因素(意识水平P<0.001,余均P<0.05)。多元逐步判别分析结果显示,仅有意识障碍、出血量2个危险因素可作为判别因子,应用建立的判别模型方程进行组内回代检验,显示判别模型方程准确度为75.3%。结论意识水平、出血量是影响脑出血患者微创术治疗预后的最重要危险因素,由此建立的30d生存和死亡的判别模型对临床具有一定的指导意义。

To discuss the prognostic risk factors which influence the patients with spontaneous supratentorial cerebral hemorrhage and treated by minimally invasive operation, and to develop a discriminant analysis model for prognosis after we used minimally invasive operation to treat supratentorial cerebral hemorrhage 30 days later. Medical records of 97 patients with spontaneous supratentorial hemorrhage and treated by minimally invasive operation were respectively reviewed. We analysed the prognostic risk factors after minimally invasive operation by univariate and multivariate logistic regression analysis. There were 27 patients died after minimally invasive operation 30 days later among the total 97 patients(27.8%). It suggests in univariate analysis that initial level of consciousness (P <0.001), hemorrhage size, the hemishere of haemorrhage, ischemic heart disease and the operation time (P <0.05) are the risk factors that had influenced prognosis. It suggested in multivariate logistic regression analysis that only initial level of consciousness and hemorrhage size were the discriminant factors and we should develop the equation of discriminant analysis model to check up the regression among groups. The accuracy of our equation was 75.3%. [Conclusion] The initial level of consciousness and hemorrhage size are the most important risk factors which affect the prognosis in the patients with spontaneous supratentorial cerebral hemorrhage and treated by minimally invasive operation, so there is a certain extent instructional sense to develop a discriminant analysis model of survival and death after minimally invasive operation 30 days later.