重症颅内静脉系统血栓形成患者预后的影响因素分析

Analysis of prognostic risk factors in patients with severe cerebral venous sinus thrombosis

目的分析颅内静脉系统血栓形成(CVT)患者预后的影响因素。方法对80例重症CVT患者的临床资料进行回顾性队列分析。按结局分为生存组与死亡组,按格拉斯哥预后评分(GOS)分为预后良好组与预后不良组。临床资料及其预后采用单因素和多因素Logistic回归分析。结果 80例重症CVT患者出院时生存65例(81.2%),死亡15例(18.8%);预后良好49例(61.2%),预后不良31例(38.8%)。①单因素Logistic回归分析结果显示,昏迷、格拉斯哥昏迷量表(GCS)评分≤8分、颅内出血、伴脑室受压/中线移位、脑疝、呼吸衰竭、低蛋白血症、低钾血症、高钠血症、血浆渗透压增高(10项因素)是死亡的影响因素。进入多因素Logistic回归分析显示,脑疝(OR=54.05,95%CI:3.40～859.55;P<0.01)、高钠血症(OR=22.50,95%CI:2.72～185.92;P<0.01)、低钾血症(OR=17.30,95%CI:1.54～193.55;P=0.02)是死亡的独立危险因素。②年龄、性别、昏迷、GCS≤8分、病变累及≥3个静脉窦/静脉、伴脑室受压/中线移位、脑疝、肺炎、呼吸衰竭、高钠血症、低钾血症、血浆渗透压增高(12项因素)是预后不良的影响因素。经多因素Logistic回归分析,年龄(≥45岁)(OR=9.47,95%CI:1.71～52.46,P=0.01)和呼吸衰竭(OR=19.64,95%CI:3.06～126.02,P=0.002)是预后不良的独立影响因素。结论脑疝、高钠血症、低钾血症是重症CVT患者死亡的独立危险因素,中老年和呼吸衰竭是重症CVT患者预后不良的独立危险因素。

Objective To analyze the prognostic risk factors in patients with severe cerebral venous sinus thrombosis （CVST）. Methods The retrospective cohort analysis of the clinical data in 80 patients with severe CVST was conducted retrospectively. The patients were divided into either a survival group or a fatal group according to their outcomes. They were also divided into a good prognosis group and a poor prognosis group according to Glasgow outcome scale （GOS）. The clinical data and prognosis were analyzed by univariate analysis and multivariate logistic regression analysis. Results At discharge, the survival, fatal,good prognosis and poor prognosis in the 80 patients with CVST were 65 （81.2%）, 15 （ 18.8% ） ,49 （61.2%） ,and 31 （38.8%） ,respectively. ①The 10 factors including coma, Glasgow Coma Scale（GCS） ≤8, intracranial hemorrhage, ventricular compression/midline shift, brain herniation, Glasgow Coma Scale （GCS） ≤8,intracranial hemorrhage,hypernatremia and hyperosmosis were the influencing factors of death. Multivariate logistic regression analysis showed that brain herniation （ OR = 54.05,95% CI 3.40-859.55 ; P 〈 0.01 ）, hypernatremia （ OR = 22.50,95 % CI 2.72 - 185.92 ; P 〈 0.01 ） and hypokalemia （ OR = 17.30,95% CI 1.54 -193.55; P =0.02） were the independent risk factors for death. ②The 12 factors, including age,gender,coma, GCS ≤ 8, the lesions involved more than 3 venous sinus or veins, ventricular compression and midline shifting, brain herniation, pneumonia, respiratory failure, hypokalemia hypernatre-mia and hyperosmosis were the influencing factors of poor prognosis. Multivariate logistic regression analysis showed that age （≥45 years old） （ OR = 9.47,95% （51 1.71-52.46 ; P= 0.01 ） and respiratory failure （ OR = 19.64,95 % CI 3.06 - 126.02 ; P = 0. 002 ） were the independent influencing factors of poor progno-sis. Conclusion Brain herniation, hypernatremia and hypokalemia arc the independent risk factors for fa-tal result in patients with severe CVST. The elderly and respiratory failure are the independent risk factors for poor prognosis in patients with severe CVST.