幕上高血压脑出血术后近期预后的影响因素分析

Factors Influencing Early Prognosis after Surgical Treatment of Supratentorial Hypertensive Intracerebral Hemorrhage

目的:探讨幕上高血压脑出血手术治疗近期预后的影响因素。方法:回顾经手术治疗的73例幕上高血压脑出血患者的临床资料,分析患者性别、年龄、术前GCS评分、出血部位、术前瞳孔有无散大、出血是否破入脑室、出血量、手术时机8个因素对患者预后的影响。评定患者日常生活能力(ADL)分级,将ADL 1-3级划为预后良好组,ADL 4-6级划为预后差组。结果:预后良好组和预后差组在术前GCS评分、出血量、出血是否破入脑室、术前瞳孔有无散大及手术时机上在统计学上有显著性差异(P<0.05),而患者的年龄、性别及出血部位则在统计学上未见显著性差异(P>0.05)。Logistic回归分析,术前GCS评分、出血量、出血是否破入脑室与预后ADL分级相关(P<0.05)。其相关系数分别为:-0.456、0.124、0.341。结论:术前GCS评分、出血量、出血是否破入脑室是估计患者手术治疗近期预后有意义的指标,术前瞳孔有无散大、手术时机对评价患者预后有一定的参考价值。了解影响高血压脑出血预后的因素可以更有效的制定治疗方案,估计预后。

Objective： To investigate the factors influencing early prognosis after surgical treatment of supratentorial hypertensive intracerebral hemorrhage.Methods： The clinical data of 73 cases of supratentorial hypertensive intracerebral hemorrhage treated surgically were reviewed.Eight prognostic factors were analyzed.They were sex,age,Glasgow Coma Scale score（GCS）,hematoma location,preoperative status of pupils,secondary intraventricular hemorrhage,volume of intracerebral hematoma and operative timing.Grade 1-3 of Activities of Daily Living（ADL） was regarded as good prognosis,and grade 4-6 as poor prognosis.Results： There were statistically significant differences between the good and the poor prognosis group in following aspects： Glasgow Coma Scale（GCS） score,preoperative status of pupils,secondary intraventricular hemorrhage,volume of intracerebral hematoma,operative timing（P〈0.05）.While the sex,age and hemorrhage location had no significant difference（P〉0.05）.Logistic regression confirmed that GCS score,secondary intraventricular hemorrhage,volume of intracerebral hematoma were related to ADL grades（r,-0.456,0.124,0.341,P〈0.05）.Conclusion： Preoperative GCS score,secondary intraventricular hemorrhage,volume of intracerebral hematoma are the most valuable indices for the early prognosis of surgical treatment of supratentorial hypertensive intracerebral hemorrhage.Preoperative status of pupils and operative timing have some value to evaluate the early prognosis.Understanding of the factors influencing prognosis is useful to determine treatment and evaluate the prognosis.