mGS评分对高血压脑出血破入脑室患者术后不良结局预测价值

Analysis of predictive value of mGS on postoperative adverse outcome for patients with hypertensive intracerebral hemorrhage rupturing into the ventricular system

目的探讨脑室改良的Graeb评分(modified Graeb scale score,mGS)预测高血压脑出血(hypertensive intracerebral hemorrhage,HICH)破入脑室术后不良结局的价值。方法回顾分析2015年1月至2019年6月我院神经外科收治的207例行手术治疗的HICH破入脑室患者的临床资料。根据出院后3个月格拉斯哥预后分级(Glasgow outcome scale,GOS)将患者分为预后不良组(GOSⅠ、Ⅱ、Ⅲ级)106例和预后良好组(GOSⅣ、Ⅴ级)101例。使用mGS评估脑室出血严重程度。通过单因素和多因素logistic回归分析,揭示预后的危险因素,采用受试者特征工作(ROC)曲线分析mGS评分预测预后的能力。结果通过多因素logistic回归分析,脑室mGS评分与不良预后独立相关(OR=1.357,95%CI:1.211~1.521,P<0.001),同时结果还显示年龄、脑疝、GCS评分为预后的独立影响因素(均P<0.05)。脑室mGS的曲线下面积(AUC)为0.839(95%CI:0.787~0.891,P<0.001),约登指数0.4893,截断值14分。结论mGS评分具有较好预测高血压脑出血破入脑室患者术后不良结局的价值,mGS>14分患者预后可能更差。

Objective To investigate predictive value of mGS on postoperative adverse outcome for patients with hypertensive intracerebral hemorrhage rupturing into the ventricular system.Methods Clinical data of 207 patients with HICH rupturing into the ventricular system admitted to the hospital from January 2015 to June 2019 were retrospectively analyzed.The patients were divided into the group of poor prognosis[Glasgow Outcome Scale(GOS)Ⅰ-Ⅲ,n=106]and the group of good prognosis(GOSⅣ-Ⅴ,n=101)according to GOS at three months after discharge.The modified Graeb Scale score(mGS)was used to assess the severity of intraventricular hemorrhage(IVH)secondary to HICH.Univariate and multivariate binary Logistic regression analysis were used to analyze the independent risk factors.The receiver operating characteristic(ROC)curve was applied to analyze the predictive value of mGS.Results Multivariate binary logistic regression analysis showed that mGS was independently correlated with poor prognosis(OR=1.357,95%CI:1.211~1.521,P<0.001).The result also revealed that age,cerebral hernia and GCS were independent prognostic factors(P<0.05).The area under the curve(AUC)of mGS was 0.839(95%CI:0.787~0.891,P<0.001).Youden index was 0.4893,cut-off value was 14.Conclusion The mGS has great predictive value on postoperative adverse outcome for patients with HICH rupturing into the ventricular system,and the prognosis may be worse when mGS score is greater than 14.