基底节区出血术后综合治疗疗效和影响因素分析

Postoperative combined modality therapy for patients with basal ganglia hemorrhage

目的探讨基底节区出血术后综合治疗疗效的影响因素。方法回顾性分析我院基底节区高血压脑出血微创血肿清除置管引流术后患者249例的临床资料。将年龄、性别、糖尿病、高脂血症、出血部位、血肿量、发病到手术间隔、残留血肿量、引流放置时间等列为影响因素，通过日常生活能力分级（ADL）评定术后3个月时的疗效，并分析影响因素与疗效的关系。结果术后3个月时随访ADL分级I级者9例（3．6％），Ⅱ级者65例（26．1％），Ⅲ级者93例（37．3％），Ⅳ级者36例（14．5％），V级者46例（18．5％）。单因素分析显示，年龄、糖尿病、血肿量、残留血肿量、引流管放置时间等因素对术后综合治疗疗效影响有统计学意义（P〈0．05）；性别、高脂血症、出血部位、发病到手术时间间隔等因素对疗效的影响无统计学意义（P〉0．05）。非条件Logistic回归分析显示，糖尿病、血肿量及引流管放置时间对治疗疗效影响有统计学意义[糖尿病（OR=8．097，95％CI2．909-22．541，P〈0．01）；血肿量（OR=14．756，95％CI3．986-54．623，P〈0．01）；引流管放置时间（OR=7．229，95％CI1．196-43．679，P〈0．05）]。结论基底节区高血压脑出血微创血肿清除结合药物和高压氧综合治疗对神经功能恢复效果良好；血肿量是影响疗效的最主要因素，应通过控制血糖和有效引流促进术后综合治疗的疗效。

Objective To analyze the therapeutic influencing factors of postoperative combined modality treatment for patients with basal ganglia hemorrhage. Methods The clinical characteristics of patients undergoing minimally invasive evacuation and catheter-based drainage with basal ganglia hemorrhage were analyzed retrospectively. Age, gender, diabetes, hyperlipidemia, clot position, volume, interval between symptom onset and operation, clot residual, drainage duration were analyzed. Therapeutic effect at 3 months after surgery was evaluated by activities of daily living （ADL） grade, and then, chi-square test and non-condition logistic regression analysis were used to define the relationship between the effect and factors. Results ADL grade at 3 months after surgery demonstrated that there were 9 （3.6%）, 65 （26. 1% ）, 93 （37. 3% ）, 36 （ 14. 5% ）, and 46 （18. 5% ） cases with grade Ⅰ , Ⅱ , Ⅲ, Ⅳ, and V respectively. Factors including age, diabetes, clot volume, clot residual and drainage duration were significantly related to therapeutic effect by Pearson chi-square test （ P 〈 0. 05 ）. Factors including gender, hyperlipidemia, clot position, interval between symptom onset and operation did not show statistically significant difference （P 〉 0. 05 ）. Diabetes （ OR = 8. 097,95 % CI 2. 909 -22. 541, P 〈 0.01 ）, clot volume （ OR =14. 756,95 % CI 3. 986 - 54. 623, P 〈 0. 01 ）, and drainage duration （ OR = 7. 229,95% CI 1. 196 - 43. 679, P 〈 0. 05） had statistical significance by the non-condition logistic regression analysis. Conclusions Rehabilitation of nervous function is achieved by combined treatment including minimally invasive evacuation, medicine and hyperbaric oxygen therapy for basal ganglia hypertensive hemorrhage. Colt volume plays a predominant role influencing therapeutic effects. Attention should be paid to control hyperglycemia and drainage clot to fulfill the purpose of improving postoperative combined therapeutic effect.