脑室出血患者行脑室外引流术后死亡的危险因素分析

Analysis of the Risk Factors of Postoperative Motality after External Ventricular Drainage in Patients with Intraventricular Hemorrhage

目的分析脑室出血行脑室外引流术术后死亡的危险因素,为制定科学的医疗措施提供指导依据。方法以我院2013年1月至2015年12月间收治的120例行脑室外引流术治疗的脑室出血患者为研究对象,对患者的临床资料进行回顾性分析。结果本组研究的120例患者中,死亡41例,死亡率为34.2%。单因素分析显示,年龄≥70岁、高血压史、入院时GCS评分<9分、脑室铸型、术前凝血功能异常、术前平均动脉压≥140 mm Hg(1 mm Hg=0.133 k Pa)、术前并发梗阻性脑积水、引流持续时间、术后并发中枢性高热、术后并发肺部感染、术后并发消化道出血的患者术后死亡发生率更高,差异有统计学意义(P<0.05)。Logistic回归分析显示,脑室出血行脑室外引流术后死亡的独立危险因素主要有(按照相对危险度从大到小排序):术后并发中枢性高热、术前并发梗阻性脑积水、引流持续时间≥7 d、术后并发肺部感染、年龄≥70岁、入院时GCS评分<9分、脑室铸型、高血压史(P<0.05)。结论脑室出血行脑室外引流术后死亡的影响因素主要与患者术前一般情况、出血程度及预后情况密切相关,采取积极的并发症防治措施是改善预后、降低术后死亡率的重要策略。

Objective To analyze the risk factors related to postoperative motality after external ventricular drainage for intraventricular hemorrhage（ IVH）. Method From January 2013 to December 2015,the clinical data of 120 IVH patients in our hospital were collected as the research object for retrospective analysis.Results Of 120 patients,41 patients died（ 34. 2%）. Mono-factorial analysis showed that the IVH mortality was higher with the risk factors of elderly age（ ≥70 years）,history of hypertension,admission GCS score 〈 9,ventricular casting,preoperative coagulation abnormality,preoperative high mean arterial pressure（ ≥140 mm Hg）,preoperative obstructive hydrocephalus,drainage duration,postoperative central high pyrexia,postoperative pulmonary infection and postoperative hemorrhage of digestive tract（ P 〈 0. 05）. Multi-factorial logistic regression analysis,on the other hand,demonstrated that the independent risk factors associated with postoperative IVH mortality were（ according to the decrescent OR） ： postoperative central high pyrexia,preoperative obstructive hydrocephalus,drainage after operation≥7 days,postoperative pulmonary infection,age ≥70 years,admission GCS score 〈 9,ventricular casting and history of hypertension（ P 〈 0. 05）. Conclusion General condition,extent of hemorrhage and prognosis of patients with IVH are likely related to mortality,and active prevention against various complications is the important strategy to improve prognosis and to decrease postoperative mortality.