自发性脑出血术后慢性脑积水形成的危险因素及其预测价值

Risk factors and predictive value for postoperative chronic hydrocephalus in patients with spontaneous intracerebral hemorrhage

目的探讨自发性脑出血(SICH)患者术后形成慢性脑积水(HCP)的危险因素及其预测能力。方法回顾分析2017年6月至2020年12月我院神经外科收治的182例行手术治疗的SICH患者的临床资料。根据出院后3个月是否形成慢性脑积水将患者分为脑积水组(37例)和非脑积水组(145例)。通过单因素和多因素Logistic回归,分析发生慢性脑积水的危险因素,采用受试者特征工作(ROC)曲线探讨危险因素对慢性脑积水的预测能力。结果通过多因素Logistic回归分析,术前mGS评分(OR=1.136,95%CI:1.043~1.238,P=0.003),术后GCS评分(OR=0.697,95%CI:0.494~0.983,P=0.040)、术后硬膜下积液(OR=4.377,95%CI:1.224~15.649,P=0.023)与慢性脑积水的发生独立相关。上述危险因素的曲线下面积(AUC)分别为0.765(截断值11分)、0.784(截断值8分)、0.624,联合预测慢性脑积水的AUC为0.872(95%CI:0.815~0.917,P<0.001)。结论术前mGS评分(>11分),术后GCS评分(<8分)、术后硬膜下积液是SICH患者术后形成慢性脑积水的危险因素,联合应用可提高对慢性HCP的预测价值。

Objective To investigate the risk factors for postoperative chronic hydrocephalus(HCP)in patients with spontaneous intracerebral hemorrhage(SICH)and to analyze their predictive value for HCP.Methods Clinical data of 182 patients with SICH admitted to the hospital from June 2017 to December 2020 were retrospectively analyzed.Patients were divided into chronic hydrocephalus group(n=37)and non-HCP group(n=145)according to whether chronic HCP formed at three months after discharge.By univariate and multivariate binary Logistic regression analysis,independent risk factors for HCP were detected.The receiver operating characteristic(ROC)curve was applied to analyze the predic-tive value of the risk factors.Results Multivariate binary logistic regression analysis showed that pre-operative modified Graeb Scale(mGS)(OR=1.136,95%CI:1.043~1.238,P=0.003),post-operative Glasgow Coma Scale(GCS)(OR=0.697,95%CI:0.494~0.983,P=0.040),post-operative subdural effusion(OR=4.377.95%CI:1.224~15.649,P=0.023)were independently correlated with chronic HCP.ROC curves showed the area under the curves(AUC)of those independent risk factors for HCP were 0.765(11 points as the threshold for pre-operative mGS),0.784(8 points as the threshold for post-operative GCS),0.624,respectively.The AUC of the risk factors combined to predict HCP was 0.872(95%CI:0.815~0.917,P<0.001).Conclusion Pre-operative mGS score(>11 points),post-operative GCS score(<8 points),post-operative subdural effusion are independent risk factors for chronic hydrocephalus.Those indexes could be jointly applied to improve the predictive value for chronic HCP.