原发性脑干出血患者死亡的独立危险因素分析

Analysis of independent risk factors in deaths of patients with primary brainstem hemorrhage

目的探讨引发原发性脑干出血患者死亡的独立危险因素。方法回顾性纳入2000年1月至2016年12月陆军军医大学西南医院神经外科收治的132例(存活88例,死亡44例)原发性脑干出血患者。采用卡方或秩和检验对患者的年龄、性别、既往史、入院时生命体征、血肿体积等相关危险因素进行单因素分析,明确原发性脑干出血患者发病后30 d存活的危险因素;进一步采用多因素logistic回归分析,明确引发原发性脑干出血患者死亡的独立危险因素。结果患者30 d生存率的单因素分析结果显示,年龄(P=0.017)、原发性高血压(P=0.002)、格拉斯哥昏迷评分(GCS)(P<0.001)、美国国立卫生研究院卒中量表(NIHSS)评分(P<0.001)、血肿体积(P<0.001)、合并脑室出血(P=0.014)、合并脑积水(P<0.001)是影响患者生存率的危险因素。多因素logistic回归分析结果显示,入院时GCS评分为原发性脑干出血死亡的独立危险因素(OR=0.619,95% CI: 0.414~0.926,P=0.019)。结论入院时GCS评分为原发性脑干出血死因的独立危险因素。

Objective To identify independent risk factor(s) in deaths of patients with primary brainstem hemorrhage. MethodsA total of 132 patients with primary brainstem hemorrhage (survival in 88 cases and death in 44 cases) were retrospectively enrolled into this study who were admitted to Department of Neurosurgery,Southwest Hospital,Army Medical University from January 2000 to December 2016. Chi-square test for age,sex,medical history,vital signs at admission or the rank sum test for hematoma volume was performed between the two groups to identify risk factor(s) affecting the survival at 30 days post primary brainstem hemorrhage. Furthermore,multivariate Logistic regression analysis was employed to identify independent risk factors of deaths in patients with primary brainstem hemorrhage. ResultsUnivariate regression analysis related to the survival rate within 30 days indicated that risk factors were as follows: age (P=0.017),hypertension (P=0.002),GCS (Glasgow coma scale) score (P<0.001),NIHSS (National Institute of Health Stroke Scale) score (P<0.001),hematoma volume (P<0.001),combined ventricular hemorrhage (P=0.014) and hydrocephalus (P<0.001). The multivariate Logistic regression analysis data showed that GCS score on admission (OR=0.619,95% CI: 0.414-0.926,P=0.019) was an independent risk factor in patients with primary brainstem hemorrhage. ConclusionGCS score on admission is an independent risk factor inducing death in patients with primary brainstem hemorrhage.