自发性基底节区不同部位出血对患者预后的影响

Influence of spontaneous bleeding from different parts of basal ganglia on patients’prognosis

目的探索基底节区不同部位出血能否预测患者的预后,并分析影响预后的相关因素,为基底节区脑出血患者判断临床预后、制定治疗方案提供参考依据。方法对362例基底节区脑出血患者以影像学和解剖学为基础确定基底节区出血的部位,根据不同出血部位将其分为前部型、内侧型、后内侧型、外侧型、后外侧型和混合型。收集患者临床特征、影像学特征和住院治疗情况,以出院6个月的结果分为预后良好组(mRS 0~2分)和预后不良组(mRS 3~6分),采用单因素和多因素回归分析脑出血预后不良的独立预测因素。结果前部型和后内侧型的出血量较少,致死率较低,预后较其他分型好;内侧型出血容易导致更多的神经功能缺陷;外侧型、后外侧型和混合型出血量较大,致死率较高。多变量分析显示,血肿累及内囊、脑叶皮质、脑室会增加预后不良的风险;GCS评分越低、血肿体积越大时,预后不良的风险越大(P<0.05)。结论除了常见的临床特征和生化指标外,出血位置及血肿累及的邻近区域也是基底节区脑出血患者预后的影响因素,基于解剖学和影像学的6种分型方法可以有效预测临床预后并指导治疗。

Objective To explore whether the different parts of basal ganglia hemorrhage can predict the prognosis of patients,and to analyze the related factors affecting the prognosis,so as to provide reference for assessing clinical prognosis and formulating treatment plans for patients with cerebral hemorrhage in basal ganglia region.Methods A total of 362 patients with basal ganglia hemorrhage were identified on the basis of imaging and anatomy.The basal ganglia hemorrhage was divided into the anterior type,the medial type,the posteromedial type,the lateral type,the posterolateral type and the mixed type according to different bleeding sites.The clinical features,imaging characteristics and hospital course of the patients were collected.After 6 months of discharge,the patients were divided into the good prognosis group(mRS 0 to 2 points)and the poor prognosis group(mRS 3 to 6 points).The univariate and multivariate regression analysis were used to obtain the independent predictors of poor prognosis of intracerebral hemorrhage.Results The anterior type and the posteromedial type had less bleeding,lower mortality,and better prognosis than the other types.The medial type had more neurological deficits.The lateral type,posterolateral type and mixed type had larger amount of bleeding and higher mortality.Multivariate analysis indicated that hematoma involved the internal capsule,lobar cortex,and ventricle increased the risk of poor prognosis.Lower GCS score and the larger hematoma volume would have a higher risk of poor prognosis(P<0.05).Conclusion In addition to the common clinical features and biochemical indicators,the location of the hematoma and its surrounding area are also the prognostic factors for basal ganglia hemorrhage.According to the 6 types of basal ganglia hemorrhage based on anatomy and imaging,it can effectively predict clinical prognosis and guide treatment.