原发性脑室出血预后相关因素临床分析

Factors Related to prognosis in patients with Primary Intraventricular Hemorrhage:a Clinical Retrospective Multivariate Analysis

目的探讨与原发性脑室内出血(IVH)预后风险独立相关的因素。方法采用回顾性病例-对照研究,收集发病24h内入院的90例成人原发性IVH患者的临床资料,3个月后用GOS评分判定预后。用统计学软件进行单因素和多因素分析各个参数与预后的关系。结果单因素分析中与预后相关的因素包括年龄、平均动脉压、美国国立卫生研究院卒中量表(NIHSS)评分、GCS评分、瞳孔不等大、血糖、IVH量、IVH范围、第四脑室状态、脑室颅腔比(VCR)(P<0.05或P<0.01)。多因素Logistic回归分析表明,与死亡独立相关的变量依作用大小依次为第四脑室出血性扩张、低GCS评分、瞳孔不等大、弥漫性IVH、高NIHSS评分(P<0.05或P<0.01),尤以第四脑室出血性扩张最有意义(P<0.01);而预后良好的独立预测因子包括低体温和低NIHSS评分(P<0.05或P<0.01)。结论及时解除第四脑室出血对脑干的压迫,防止脑干功能进一步恶化及低温治疗将有助于降低IVH患者的死亡率,改善其生存质量。

Objective To explore the factor related to the prognosis in the patients with primary intraventricular hemorrhage （PIVH）. Methods The clinical data of 90 patients who were admitted in the hospital after PIVH were collected. The prognosis of all the patients was assessed by GOS 3 months after the hemorrhage. The factors related to prognosis were analyzed by univariate analysis and multivariate analysis. Results The univariate analysis showed that the factors related to the prognosis in the patients with PIVH included the age, mean arterial blood pressure, GCS, score of National Institutes of health stroke scale （NIHSS）, anisocoria, serum glucose, volume and extent of intraventricular hemorrhage （IVH）, the situation of the fourth ventricle and ventriculocranial ratio（VCR）. The multivariate Logistic regression analysis showed that the independent dead predictors included hemorrhagic dilation of the fourth ventricle （P〈0.01）, low GCS （P〈0.05）, anisocoria （P〈0.05）, diffuse IVH （P〈0.05） and high NIHSS score （P〈0.05）. The independent predictors of good outcome included low temperature （P〈0.05） and low NIHSS score （P〈0.05）. Conclusions The hemorrhagic dilation of the fourth ventricle is the strongest dead predictor, and low temperature, and low NIHSS score are the independent predictors of good outcome in the patients with PIVH.