影响立体定向血肿引流术治疗幕上高血压脑出血预后的多因素分析

Analysis of Various Factors Influencing Prognosis of Patients with Supratentorial Hypertensive Cerebral Hemorrhage Treated by Stereotactic Aspiration and Thrombolysis

目的分析影响立体定向血肿抽吸引流术治疗幕上高血压脑出血患者预后的因素。方法三维重建单(双)靶点定向置管引流术治疗幕上高血压脑出血患者172例,将患者临床资料和随访资料输入Access数据库,利用单因素模型分析患者术后30d内死亡率、远期预后和血肿增加的影响因素,并对上述影响因素进行Logistic多变量逐步回归分析进而确定主要影响因素。结果血肿增加、肺部感染、出血部位为患者术后30d内死亡的主要影响因素;肺部感染、血肿增加、血肿波及中脑是影响患者远期预后的主要危险因素,术后两周肌力≥Ⅱ级是保护因素;血肿破入脑室(>4分)是影响血肿增加的主要危险因素。结论应用立体定向血肿抽吸引流术时,应防止血肿增加和肺部感染,以改善幕上高血压脑出血患者的预后。

Objective To analyze the risk factors of influencing the prognosis of the patients with hypertensive cerebral hemorrhage treated by stereotactic aspiration and thrombolysis. Methods One hundred and seventy-two patients with supratentorial hypertensive cerebral hemorrhage were treated by 3-D rebuilding guidance stereotactic aspiration with single or double tubes and thrombolysis. The clinical and following up data of all the patients were inputted into Access data bank. The model of single factor was employed to analyze the factors influencing mortality 30 days after the operation （30 d mortality）, long term prognosis and hematoma enlargement, and then logistic gradual regressive analysis of the major risk factors was performed. Results Hematoma enlargement, pneumonia and thalamic hemorrhage were the major risk factors of influencing 30 d mortality. Pneumonia, hematoma enlargement and hematoma involving midbrain were the major risk factors of influencing long term prognosis. The muscle strength ≥ Ⅱ 2 weeks after the operation was the protective factor. Hematoma spreading to ventricle （〉4） was the major risk factor of hematoma enlargement. Conclusions We should take measure to avoid hematoma enlargement and pneumonia during stereotactic aspiration and thrombolysis of intracerebral hematoma to improve the prognosis in the patients with supratentorial hypertensive cerebral hemorrhage.