高血压脑干出血预后的影响因素分析

The factors influencing prognosis on patients with hypertensive brainstem hemorrhage

目的:探讨影响高血压脑干出血预后的相关因素。方法:收集高血压脑干出血患者177例的住院诊疗和出院随访的详细资料,并分组比较分析影响患者住院死亡和出院后康复的相关因素。结果:高血压脑干出血患者住院病死率为23.7%,预后差(包括住院死亡和出院后恢复差)的患者血糖、体温均显著高于对照组(P<0.01),瞳孔变化及格拉斯哥昏迷评分(GCS)≤8分病例数明显增多,出血破入脑室多见,出血量更大,并发症肺部感染、消化道出血更多见,与对照组比较差异均有统计学意义(P<0.01)。Logistic回归分析显示高血糖、并发肺部感染与患者住院死亡独立相关(P<0.05)。手术组患者的病死率明显下降(30.0%比65.2%,P<0.01)。结论:体温、瞳孔变化、GCS评分、出血量、血糖、并发症可影响高血压脑干出血患者的预后,其中高血糖和并发肺部感染是影响患者死亡的独立危险因素。手术治疗可降低高血压脑干出血患者的病死率。

Objective: To investigate the relevant factors influencing the prognosis of hypertensive brainstem hemorrhage(HBH). Methods: A total of 177 patients with HBH were enrolled and the details of their hospitalization and follow-up were collected, grouped and compared to look for some factors which influenced the prognosis of HBH. Results: The hospital mortality rate of hypertensive brainstem hemorrhage was 23.7%. In the patients with poor prognosis(inpatient death and poor rehabilitation after discharge), blood sugar and body temperature were significantly higher than those in the control group(P<0.01), the number of cases with pupil changes and Glasgow coma score(GCS)less than 8 points increased significantly, more hemorrhage broke into ventricles and larger amount of hemorrhage was also observed, as well as more complicating with pulmonary infection or gastrointestinal bleeding, there was significant difference compared to that in the control group(P<0.01). Logistic regression showed that hyperglycemia and pulmonary infection were independently associated with hospital mortality(P< 0.05). The mortality of patients in operation group decreased significantly(30.0% vs 65.2%, P<0.01). Conclusions: The body temperature, pupil changes, GCS, amount of hemorrhage, blood sugar, complications influence the prognosis of patients with hypertensive brainstem hemorrhage. Among them, hyperglycemia and pulmonary infection are independent risk factors for hospital mortality. Surgical treatment can reduce the mortality of patients with hypertensive brainstem hemorrhage.