老年高血压性脑出血患者预后情况与CT影像诊断特征的相关性研究

Correlation between Prognosis and CT Image Features of Hypertensive Cerebral Hemorrhage in the Elderly

目的研究老年高血压性脑出血患者预后情况与CT影像诊断特征的相关性。方法选取2016年1月—2018年1月收治在复旦大学附属华东医院的高血压性脑出血患者100例,所有患者均采用64排螺旋CT进行扫描,对患者的脑出血部位、出血量、破入脑室情况、中线移位情况进行观察,并使用Barthel指数来判断所有患者预后情况,通过将不同预后患者CT检查结果进行统计,得出高血压性脑出血患者预后情况与CT影像诊断特征的相关性。结果高血压性脑出血预后情况与患者性别差异无统计学意义(P>0.05);与患者年龄具有相关性,年龄越大,预后情况越差,差异有统计学意义(P<0.05);高血压性脑出血预后情况与患者出血部位具有相关性,基底节区、丘脑、脑叶、小脑、脑干出血部位评分分别为(46.67±6.72)分、(46.68±6.87)分、(42.53±5.67)分、(39.96±4.52)分和(35.32±3.27)分,差异有统计学意义(P<0.05),出血部位为脑干和小脑的患者,其预后情况明显较差;高血压性脑出血预后情况与患者出血量具有相关性,<30 mL、30~50 m L和> 50 m L得分分别为(55.26±8.74)分、(45.23±6.80)分和(36.63±6.23)分,差异具有统计学意义(P<0.05),出血量越大,预后情况越差;高血压性脑出血预后情况与患者是否破入脑室具有相关性,破入脑室患者预后情况明显较差(P<0.05);高血压性脑出血预后情况与患者中线移位距离具有相关性,中线移位≥10 mm较<10 mm的患者预后情况明显较差,评分分别为(41.16±4.86)分和(49.36±8.27)分,差异有统计学意义(P<0.05);出血部位、出血量、破入脑室情况和中线移位情况进入Logistic模型,且均为危险因素,置信区间分别为(3.38~12.26)、(2.78~12.58)、(3.00~12.44)和(3.14~12.50)。结论 CT影像技术可以检测高血压性脑出血患者出血情况,并大致判断高血压性脑出血患者的预后情况,为患者的诊疗提供一定的价值。

Objective To explore the correlation between the prognosis and CT image features of hypertensive cerebral hemorrhage in the elderly. Methods All the 100 cases with hypertensive cerebral hemorrhage during the period from Jan., 2016 to Jan., 2018 in Huadong Hospital underwent 64 row helical CT scanning;observation was made to cerebral hemorrhage location, bleeding volume, hemorrhage broken into ventricles of brain and midline shifting;Barthel index was applied in judging the prognosis of the cases, and the CT scanning results of the cases with different prognosis were statistically analyzed so as to search out the correlation between the prognosis and CT image features of hypertensive cerebral hemorrhage. Results The gender difference in cases with hypertensive cerebral hemorrhage was of no statistical significance in prognosis (P>0.05) while age was closely correlated to prognosis, older age led to poorer prognosis, the difference was of statistical significance (P<0.05);prognosis of the cases with hypertensive cerebral hemorrhage was in correlation to hemorrhage location, the scores of the cases with hemorrhage location in basal ganglia, thalamus, cerebral lobe, cerebellumand brainstem were (46.67±6.72),(46.68±6.87),(42.53±5.67),(39.96±4.52) and (35.32±3.27) respectively, the difference was of statistical significance (P<0.05);prognosis was correlated to bleeding volume, the scores of the cases with bleeding volume <30 mL, from 30 mL to 50 mL and >50 mL were (55.26±8.74),(45.23±6.80) and (36.63±6.23), bigger bleeding volume led to poorer prognosis (P<0.05);prognosis was in correlation with the occurrence of hemorrhage broken into ventricles of brain, cases with hemorrhage broken into ventricles had obviously poorer prognosis (P<0.05);prognosis was correlated to the distance of midline shifting, cases with midline shifting ≥10 mm had poorer prognosis than cases with midline shifting <10 mm, their scores were (41.16±4.86) and (49.36±8.27) respectively (P<0.05);Logistic analysis indicated that hemorrhage location (CI: 3.38-12.26), bleeding volume (CI: 2.78-12.58), hemorrhage broken into ventricles of brain (CI: 3.00-12.44) and midline shifting (CI: 3.14-12.50) were the risk factors of hypertensive cerebral hemorrhage. Conclusions CT scanning can detect the bleeding of hypertensive cerebral hemorrhage and make out a rough judgment of the prognosis, it is of certain value in clinic.