高血压幕上脑出血预后影响因素的Logistic回归分析

Logistic regression analysis of influential factors on prognosis of supratentorial intracerebral hemorrhage in hypertensive patients

目的 探讨高血压幕上脑出血（ICH）患者28 d预后（好转与否）的影响因素,为临床诊治提供理论依据.方法 采用定群病例的前瞻性研究.预后据神经功能缺损评分分为好转（基本痊愈、显著进步和进步）和未好转（病情无变化、恶化和死亡）,对经过综合治疗的356例高血压幕上ICH患者的有关指标与28 d预后的关系进行单因素和多因素分析,多因素分析用Logistic逐步回归,前向逐步法,α=0.05.结果 Logistic逐步回归分析筛选出营养支持（OR=0.373,95% CI 0.144～0.964）、康复治疗（OR=8.822,95% CI 2.009～38.742）、血肿量（OR=0.122,95% CI 0.045～0.330）、年龄（OR=1.048,95% CI 1.004～1.095）、并发症（OR=1.021,95% CI 1.004～1.039）和Barthel指数（BI,OR=0.951,95% CI 0.914～0.990）是影响ICH预后的相关因素.结论 积极营养支持、早期康复介入、降低颅内压、防止并发症、微创清除血肿和（或）防止血肿扩大可能是改善预后的重要环节.

Objective To discuss the influencing factors associating with 28-day prognosis with 356 hypertensive supratentorial intracerebral hemorrhage （ICH） patients, so as to provide theoretical basis for clinical treatment. Methods Prospective cohort study was carried out. According to the severity of nervous dysfunction, the prognosis was rated as effective （including full recovery, significant improvement and improvement） and non-effective （including no change, deterioration and death）. Related indexes in 356 supratentorial ICH patients with hypertension were observed. Single factor analysis and multiple factors analysis were clone to analyze the relationship between these factors and 28-day prognosis. Multiple factors analysis using Logistic regression analysis, α = 0. 05. Results Logistic stepwise regression analysis screened out such factors as nutritional support （OR = 0. 373,95% CI 0. 144-0. 964 ）, rehabilitation care （ OR =8. 822,95% CI2. 009-38.742）, volume of hematoma （ OR =0. 122,95% CI0. 045-0. 330）, age （ OR = 1. 048,95% CI 1. 004-1. 095）, complications（ OR = 1. 021,95% CI 1. 004-1. 039） and Barthel index （ OR = 0. 951,95% CI 0. 914-0. 990 ） that would influence the prognosis of supratentorial ICH. Other independent variables were not in the equation. Conclusion Sufficient nutritional support, earlystage rehabilitation care, lowering of intracranial pressure, prevention of complications, minimal invasive clearance of hematoma and（or） prevention of enlargement of hematoma are important elements for improving prognosis.