脑出血预后预测模型对自发性脑出血患者功能预后的判断

Model for predicting clinical outcome of the spontaneous intracerebral hemorrhage

目的分析影响自发性脑出血患者功能预后的相关因素,提出脑出血预后判断模型,协助临床医师进行脑出血预后判断。方法回顾性分析265例脑出血患者的病史、入院时生命体征、影像学和实验室检查结果及随访30d后的Rankin指数(mRs),根据随访结果将患者分为两组:预后好组(mRs≤2分)、预后差组(mRs3～6分);应用单因素分析及Logistic多元回归分析,探讨自发性脑出血功能预后的相关因素。结果单因素分析显示下列因素与预后不良显著相关:年龄、糖尿病病史及入院时血糖水平、是否合并肺部感染、Glasgow昏迷指数、NIHSS评分、入院时ADL、入院时饮水试验评分、出血部位、出血体积、是否中线移位。Logistic多元回归分析表明:年龄、入院时ADL、NIHSS评分、出血体积与脑出血30d后预后不良相关;以此构建脑出血功能预后预测模型,该模型预测脑出血预后不良转归的阳性预测率为86.7%,阴性预测率为78.1%,预测准确率为83.3%。结论年龄、出血体积、幕上出血体积、入院时ADL、NIHSS评分可用于预测脑出血的预后,该预测模型对于脑出血起病后30d预后评估具有一定的预测效能。

Objective To guide the clinical physicians evaluating the prognosis of spontaneous intracerebral hemorrhage（ICH）,we investigated the clinical characteristics of ICH and set up a model to predict the prognosis of ICH.Methods The clinical data of 265 patients were collected and studied retrospectively.All the patients were divided into two groups：good prognosis group（mRS score ≤2 points）,and poor prognosis group （mRS score 3-6 points）.The prognostic factors were analyzed with single factor and Logistic regression analyses.Results Age,blood glucose levels,secondary pneumonia,Glasgow coma scale,NIHSS score,activity of daily living scale,drinking scores,bleeding location,amount of hemorrhage,midline of brain shift were analyzed.However,the age,ADL,NIHSS score,and amount of hemorrhage were independent predictors of prognosis for cerebral hemorrhage at 30 days.The accuracy of the predictors was 83.3％,the negative predictive rate was 78.1％ and positive predictive rate was 86.7％.Conclusions Age,ADL,NIHSS score,amount of hemorrhage may be used to predict the prognosis of cerebral hemorrhage after 30 days.