高血压性脑出血重症患者急诊手术的预后与术前相关因素分析(附60例临床分析)

Analysis of the relation between preoperative related factors in patients with hypertensive intracerebral hemorrhage undergoing emergency operation and prognosis(a clinical analysis of 60 cases)

目的探讨高血压脑出血重症患者急诊手术的预后与术前相关因素的关系。方法我院自2014年12月份至2017年3月份60例高血压脑出血重症患者进行急诊手术的术前相关资料,并追踪随访3个月,根据预后情况,分成两组:预后良好组(ADL评分I-III级)和预后不良组(ADL评分IV、V级以及死亡病人),对于年龄、性别、发病时间、有无合并其他基础疾病、术前收缩压、术前GCS评分、脑疝情况、出血部位、术前血肿量以及血肿破入脑室这些术前因素与预后的相关性进行统计学分析。结果单因素分析提示两组术前GCS评分、脑疝情况、血肿破入脑室、出血部位这些因素和预后有显著差异(P<0.05);两组性别、年龄以及术前血肿量、术前收缩压这些因素和预后无显著差异(P>0.05)。多因素Logistic回归分析结果显示脑疝情况、血肿破入脑室进入回归方程,为影响预后的独立危险因素,术前GCS评分因素达到了边缘显著意义(P=0.069)。结论脑疝、破入脑室、术前GCS评分低这些术前因素提示高血压脑出血重症患者急诊手术预后不佳。

Objective Study the relation between preoperative related factors in patients with hypertensive intracerebral hemorrhage（HICH）undergoing emergency operation and prognosis.Methods Sixty patients with severe HICH who were underwent acute surgical treatment were selected as research objects in our hospital from December 2014 to March 2017,collect all patients＇ preoperative clinical data,divide two groups（good prognosis group：ADL score I-III and bad prognosis group：ADL score IV,V）according to ADL assessment of all patients in three months after operations,statistical analysis the relation between ages,gender,time（from onset to operation）,whether or not combine basic disease,preoperative systolic pressure,preoperative Glasgow coma scale（GCS）score,whether or not cerebral herniation,hematoma location,the preoperative hematoma volume,whether or not intraventricular hematoma and prognosis.ResultsMono-agent logistic analysis displayed that there is a significant correlation between preoperative GCS score,whether or not cerebral herniation,whether or not intraventricular hematoma,hematoma location and prognosis（P〈0.05）.Multiple linear logistic regression analysis displayed that whether or not cerebral herniation,whether or not intraventricular hematoma can admit regression equation and its are independent predictors,preoperative GCS score has a marginal significant correlation（P=0.069）.Conclusion Cerebral hernia,intraventricular hematoma and low postoperation GCS score indicate the worse progonis of the patients with severe HICH who were underwent the emergency operation.