老年基底节区脑出血患者发生早期神经功能恶化的危险因素及对早期预后的影响

Association of early prognosis and risk factors about early neurological deterioration in aged patients with cerebral hemorrhage in basal ganglia

目的：探讨老年基底节区脑出血患者发生早期神经功能恶化（END）的危险因素及对早期预后的影响。方法纳入确诊为基底节区脑出血的老年患者139例，根据有无END分为END组（59例）和非END组（80例），回顾性分析两组患者的临床资料。患者于出院后3个月进行随访，采用改良Rankin量表评估预后，采用Logistic回归分析判定发生END的独立危险因素。结果 END发生率为42.4%（59/139）。END组预后不良发生率明显高于非END组[78.0%（46/59）比30.0%（24/80）]，差异有统计学意义（P＜0.05）。END组入院加拿大卒中量表（CSS）评分明显低于非END组[（5.2±2.1）分比（6.9±1.7）分]，而入院白细胞计数、血肿体积和出血破入脑室率明显高于非END组[（10.7±2.9）×109/L比（7.9±2.4）×109/L、（17.4±14.9）ml比（11.2±10.5）ml和42.4%（25/59）比18.8%（15/80）]，差异有统计学意义（P〈0.05）；两组性别构成、年龄、入院收缩压、舒张压、体温、随机血糖、纤维蛋白原、活化部分凝血酶时间、凝血酶原时间以及高血压、吸烟史、脑卒中史、糖尿病、高脂血症发生率比较差异无统计学意义（P＞0.05）。Logistic回归分析结果显示，出血破入脑室和入院白细胞计数是老年基底节脑出血患者发生END的独立危险因素（P〈0.05或〈0.01）。结论老年基底节区脑出血患者容易发生END，出血破入脑室和入院白细胞计数是老年基底节脑出血患者发生END的独立危险因素，并且患者的早期预后较差。

Objective To study the association of early prognosis and risk factors about early neurological deterioration （END） in aged patients with cerebral hemorrhage in basal ganglia. Methods One hundred and thirty-nine aged patients with cerebral hemorrhage in basal ganglia were selected. The patients were divided into END group （59 cases） and non-END group （80 cases）, the clinical data were retrospectively analyzed. The patients were followed up 3 months after discharge, the prognosis was evaluated by modified Rankin scale. Logistic regression analysis was used to determine the independent risk factors of END. Results The incidence of END was 42.4%（59/139）. The incidence of unfavourable prognosis in END group was significantly higher than that in non-END group：78.0%（46/59） vs. 30.0%（24/80）, and there was statistical difference （P〈0.05）. The score of Canadian stroke scale （CSS） at admission in END group was significantly lower than that in non-END group： （5.2 ± 2.1） scores vs. （6.9 ± 1.7） scores, but the white blood cell count at admission, hematoma volume and brain ventricle hemorrhage rate were significantly higher than those in non-END group： （10.7 ± 2.9） × 109/L vs.＆nbsp;（7.9 ± 2.4） × 109/L, （17.4 ± 14.9） ml vs. （11.2 ± 10.5） ml and 42.4%（25/59） vs. 18.8%（15/80）, and there were statistical differences （P 0.05）. The Logistic regression analysis results showed that brain ventricle hemorrhage and white blood cell count at admission were independent risks factor for END in aged patients with cerebral hemorrhage in basal ganglia（P 〈 0.05 or 〈 0.01）. Conclusions The aged patients with cerebral hemorrhage in basal ganglia will be prone to END, the brain ventricle hemorrhage and white blood cell count at admission are independent risks factor for END, and the early prognosis is poor.