基底节区脑出血患者发生早期神经功能恶化危险因素的Logistic回归分析及临床急救

The clinical emergency and Logistic regression analysis of factors of early neurological deterioration in patients with cerebral hemorrhage in basal ganglia

目的:探讨基底节区脑出血患者发生早期神经功能恶化(END)的危险因素及临床急救,并通过Logistic回归分析其危险因素。方法:选取2012-01-2014-12我院神经内科收治的122例基底节区脑出血患者,根据其是否发生END,分为END组(n=60)和非END组(n=62),对比分析2组患者一般临床资料、实验室检查资料以及影像学资料,并进行多因素的Logistic回归分析,判定基底节区脑出血患者发生END的独立危险因素;将END组患者随机分为观察组和对照组,每组各30例,观察组患者在内科保守方式基础上行超早期微创穿刺引流组术急救,对照组行内科保守方式,对比2组患者的临床效果。结果:END组患者的NIHSS评分、白细胞计数(WBC)、血清汇总肿瘤坏死因子-α(TNF-α)浓度、白介素-6(IL-6)浓度、颅内血肿体积、出血是否破入脑室比例均显著高于非END组(P<0.05),基底节区脑出血患者发生END的独立危险因素是出血破入脑室和WBC;观察组患者的临床治愈率显著高于对照组(100.00%vs.83.33%,P<0.05)。结论:基底节区脑出血患者WBC越高、出血破入脑室概率越大,END的发生率就越高,患者预后便越差;当基底节区脑出血患者发生END时应立即采取超早期微创穿刺引流术进行临床急救,疗效显著,值得临床进一步推广使用。

Objective：To investigate the occurrence of basal ganglia in patients with cerebral hemorrhage early neurological deterioration（END）risk factors and clinical emergency,and to analyze the risk factors by Logistic regression.Method：Selecting 122 cases of basal ganglia intracerebral hemorrhage patients in our hospital neurology from January 2012 to December 2014,according to whether they occur END,who were divided into END group（n=60）and non-END group（n=62）.The comparisons of clinical data,laboratory data and radiological datas were undergone between two groups,when a sigle factor analysis showed statist results：After the corresponding nursing,the clinical cure rate significance,multivariate Logistic regression model analysis was performed to determine the independent risk factors for END in patients with cerebral hemorrhage in hasalganlia region.Sixty patients in END group were randomly divided into observation group and control group,with 30 cases in each group.Control group was given conservative way of treatment,while the observation group was given ultra-early minimally invasive on the basis of conservative treatment.The comparisons of clinical efficacy.Result：The NIHSS score,WBC count,TNF-αconcentration,IL-6concentration,intracerebralhemorrgage volume,incidence of intraventricular hemorrhage of END group were significantly higher than those of non-END group,there were significant defferences,and the logistic regression analysis showed that WBC count,hemorrhage breaking into ventricles of brain were the independent factors for the occurrence of END in patients with cerebral hemorrhage in basal ganglia.Theclinical cure rate of the control group was 83.33%,which was 100.00%in the observation group,the difference was significant when compared with the control group（P〈0.05）.Conclusion：The higher WBC count and intraventricular hemorrhage,the more likely END will happen in patients with cerebral hemorrhage in basal ganglia,and which means a worse outcome for patients,and the observation group was given ultra-early minimally invasive on the basis of conservative treatment for clinical emergency,which is worth further clinical application.