幕上高血压性脑出血微创颅内血肿抽吸引流术1年预后相关因素分析

Analysis of Related Factors of 1-year Outcome of Minimally Invasive Surgery in Supratentorial Spontaneous Intracerebral Hemorrhage

目的探讨幕上高血压性脑出血(intracerebral hemorrhage,ICH)微创颅内血肿抽吸引流术1年预后及其相关因素。方法收集2014年1月-2016年8月就诊的进行微创颅内血肿抽吸引流术的幕上高血压性ICH患者。记录患者人口学特征等基本信息、临床信息、手术治疗信息及1年改良Rankin量表(modified Rankin scale,mRS)评分。主要临床结局为1年预后不良,定义为1年mRS>3分。用多因素Logistic回归分析1年预后不良的相关因素。结果研究共纳入117例完成微创颅内血肿抽吸引流术的幕上高血压性ICH患者。平均年龄(56.5±12.5)岁,基线血肿体积(59.0±28.5)ml。59例(50.4%)ICH患者1年预后不良。多因素Logistic回归分析显示,基线血肿体积20～50 ml[比值比(odds ratio,OR)0.161,95%置信区间(confidence interval,CI)0.034～0.748,P=0.020]、年龄≤60岁(OR 0.169,95%CI 0.055～0.515,P=0.002)是1年预后不良的保护性因素。结论基线血肿体积和年龄是幕上高血压性ICH微创颅内血肿抽吸引流术1年预后的独立影响因素,该结论为选择微创颅内血肿抽吸引流术适宜人群提供依据。

Objective To study 1-year clinical outcomes after minimally invasive catheter evacuation followed by urokinase for clot removal in patients with acute supratentorial spontaneous intracerebral hemorrhage（ICH） and determine the factors associated with the 1-year outcome.Methods Supratentorial spontaneous ICH patients who had undergone minimally invasive catheter evacuation followed by urokinase for clot removal during January 2014 and September 2016 were collected. Patients＇ demographic and clinical information, surgery information and one-year modified Rankin scale（mRS） were recorded. The main clinical outcome was poor outcome, defined as mRS score 3 at 1 year. The multi-factor logistic regression analysis was used to determine factors associated with 1-year clinical outcome after ICH.Results A total of 117 patients with supratentorial spontaneous ICH and having undergone minimally invasive surgery were enrolled in the study. The mean age was（56.5±12.5） years and the mean baseline hematoma volume was（59.0±28.5） ml. 59（50.4%） ICH patients had 1-year poor outcome after surgery. Multi-factor Logistic regression analysis revealed that baseline hematoma volume 20-50 ml [odds ratio（OR） 0.161, 95% confidence interval（CI） 0.034-0.748, P=0.020] and age≤60 years（OR 0.169, 95%CI 0.055-0.515, P=0.002） were independent protective factors of 1-year poor outcome.Conclusion Baseline hematoma volume and age were independent predictors of 1-year outcome in acute ICH patients who had undergone minimally invasive surgery, which could allow better selection of ICH patients appropriate for minimally invasive surgery.