高血压性脑出血术后慢性意识障碍的危险因素分析

Risk factors of postoperative prolonged disorders of consciousness in patients with hypertensive intracerebral hemorrhage

目的探讨高血压性脑出血(HICH)术后发生慢性意识障碍(pDoC)的危险因素。方法回顾性分析2017年12月至2021年7月手术治疗的163例HICH的临床资料。术后昏迷时间>28 d诊断为pDoC。结果163例中,57例发生pDoC,发生率为35.0%。多因素logistic回归分析显示,高龄(OR=1.092,95%CI:1.044~1.142,P<0.001)、入院GCS评分低(OR=0.671,95%CI:0.488~0.922,P=0.014)、术前脑疝(OR=3.058,95%CI:1.122~8.337,P=0.029)、慢性脑积水(OR=4.694,95%CI:1.584~13.906,P=0.005)是HICH术后发生pDoC的独立危险因素(P<0.05)。ROC曲线分析结果显示,年龄≥70岁、入院GCS评分≤6分、术前脑疝、慢性脑积水联合预测术后发生pDoC的效果良好,AUC=0.871(95%CI 0.809~0.918;P<0.001),特异度=92.45%,灵敏度=73.68%。结论高年龄、入院GCS评分低、术前存在脑疝、慢性脑积水的HICH病人术后发生pDoC的风险明显增加,临床应采取相应干预措施,以改善病人预后。

Objective To analyze the risk factors of postoperative prolonged disorders of consciousness(pDoC) in the patients with hypertensive intracerebral hemorrhage(HICH). Methods The clinical data of 163 patients with HICH who underwent surgery from December 2017 to July 2021 were retrospectively analyzed. Postoperative coma lasting more than 28 days was diagnosed as pDoC.Results Of these 163 patients, 57 patients suffered from pDoC, and the incidence rate was 35.0%. Multivariate logistic regression analysis showed that older age(OR=1.092, 95% CI 1.044~1.142, P<0.001), lower admission GCS score(OR=0.671, 95% CI 0.488~0.922, P=0.014), preoperative herniation(OR=3.058, 95%CI 1.122~8.337, P=0.029), chronic hydrocephalus(OR=4.694, 95%CI 1.584~13.906, P=0.005) were independent risk factors of postoperative p DoC in the HICH patients(P<0.05). The results of ROC curve analysis showed that the combination of age ≥70 years, GCS score ≤6 points on admission, preoperative herniation, and chronic hydrocephalus combined had a good effect on predicting the postoperative pDoC, with the AUC=0.871(95% CI 0.809~0.918;P<0.001), a specificity of92.45%, and a sensitivity of 73.68%. Conclusions HICH patients with older age, lower GCS score on admission, preoperative herniation,and chronic hydrocephalus have a significantly increased risk of postoperative pDoC. Corresponding interventions should be taken to improve the patients’ prognoses.