入院清醒自发性脑出血患者近期预后及相关因素分析

An analysis about the short term outcome and factors associated with the outcome in patients with SICH who were alert on admission

目的探讨入院时意识清醒的自发性脑出血(SICH)患者近期(28 d)预后及影响预后的相关因素。方法以神经内科收治的225例发病6 h内入院且适宜内科保守治疗的SICH患者为研究对象,根据入院时GCS评分将患者分为清醒组(GCS≥9分)和昏迷组(GCS≤8分)。记录性别、年龄、NIHSS评分等临床特征。以28 d时预后良好、残疾、死亡、死亡/残疾复合结局为判断指标,比较2组患者的临床特征、预后的异同,并对清醒组患者不同预后进行对比分析,探讨影响清醒脑出血患者预后的相关因素。结果经多因素Logistic回归分析显示,入院时高血糖(OR=1.347,95%CI 1.106～1.639,P=0.003)、高NIHSS评分(OR=1.097,95%CI 1.001～1.205,P=0.049)为28 d死亡的独立危险因素;而入院高NIHSS评分(OR=1.191,95%CI 1.111～1.275,P=0.000)、有并发症(OR=2.793,95%CI 1.054～7.401,P=0.039)为28 d时死亡/残疾复合结局的独立危险因素。结论入院NIHSS评分为清醒脑出血患者近期死亡及预后不良的重要预测因素之一;控制入院高血糖、降低并发症是减少28 d死亡、残疾的重要环节。

Objective To investigate the short term outcome and factors associated with the outcome in patients with SICH who were alert on admission.Methods 225 subjects were included,who arrived hospital within 6 hours and may be suitable for treating in the department of neurology.Patients were divided into two groups,alert group（GCS score =3 9） and comatose group（GCS score^8）.Patients with GCS score of more than 8 on admission were selected,of which clinical features about gender,age,NIHSS score,et al were recorded.The prognosis of these patients on 28 days was evaluated by the followed index,good prognosis,or disability,or death,or compounded termination of death and disability.At first,the difference of clinical feature and prognosis between the alert patients and comatose patients was analyzed.Then,the different prognosis within the alert patients was analyzed,and factors associated with the prognosis of the patients who were alert on admission were analyzed.Results By multiple logistic regression analysis,it was found that hyperglycemia（OR = 1.347,95%CI 1.106～1.639,P =0.003）,higher NIHSS score（OR = 1.097,95%CI 1.001～1.205,P =0.049） were independent risk factors for 28 day mortality,and having higher NIHSS score（OR = 1.191,95%CI 1.111～1.275,P =0.000） or complication （OR = 2.793,95%CI 1.054～7.401,P = 0.039） were also independent risk factors of compounded termination of death and disability on 28 day.Conclusion For patients who were alert on admission,having higher NIHSS score on admission is one of the important predictors for short term mortality and unfavorable outcome.Manipulation of hyperglycemia and prevention of complications are important elements for improving 28 day mortality and disability.