术前影像学指标对重度脑室内出血患者病情及预后的判断价值

Guiding value of preoperative imaging indexes evaluation in patients with severe intraventricular hemorrhage

目的探讨术前影像学指标对重度脑室内出血患者病情严重程度及预后的判断价值。方法回顾性分析45例采用双侧侧脑室额角穿刺引流的重度脑室内出血患者的临床资料。根据患者的格拉斯哥预后量表(GOS)评分将其分为预后良好组与预后不良组。患者术前行头颅CT检查,采用PACS系统测量Evans指数、第三脑室最大宽度、第四脑室最大宽度、第四脑室最大长度、颞角平均宽度、环池分级、视神经鞘平均直径、Graeb评分及改良Graeb评分(mGS)。分析比较两组患者的影像学指标,并对单因素分析有统计学意义的影像学指标进行二元Logistic回归分析。结果预后良好组与预后不良组患者的第四脑室最大宽度、第四脑室最大长度、颞角平均宽度、视神经鞘平均直径及mGS评分、环池分级的差异均有统计学意义(P<0.05~0.001)。二元Logistic回归分析显示,颞角平均宽度是影响患者预后的独立危险因素(OR值1.530,95%CI 1.055~2.220,P<0.05)。结论通过对术前头颅CT表现的分析,可以对重度脑室内出血患者的病情严重程度及预后做出初步的判断。

Objective To investigate the value of preoperative imaging indexes in judging the severity and prognosis of patients with severe intraventricular hemorrhage.Methods The clinical data of 45 patients with severe intraventricular hemorrhage who were treated with bilateral lateral ventricle frontal horn puncture drainage were retrospectively analyzed.According to the Glasgow outcome scale(GOS)score,the patients were divided into good prognosis group and poor prognosis group.The Evans index,the maximum width of the third ventricle,the maximum width of the fourth ventricle,the maximum length of the fourth ventricle,the average width of the temporal horn,the ambient cistern classification,the average diameter of the optic nerve sheath,the Graeb score and the modified Graeb score(mGS)were measured by PACS system.The imaging indexes of the two groups were analyzed and compared,and binary logistic regression analysis was performed for the imaging indexes with statistical significance in univariate analysis.Results There were significant differences in the maximum width of the fourth ventricle,the maximum length of the fourth ventricle,the average width of the temporal horn,the average diameter of the optic nerve sheath,the mGS score and the ambient cistern grade between the two groups(P<0.05~0.001).Binary logistic regression analysis showed that the average width of the temporal horn was an independent risk factor for prognosis(OR 1.530,95%CI 1.055~2.220,P<0.05).Conclusion Through the analysis of preoperative head CT findings,it can make a preliminary judgment on the severity and prognosis of patients with severe intraventricular hemorrhage.