老年高血压基底节区脑出血患者微创术后短期预后的危险因素分析

Risk factors of short-prognosis after minimally invasive surgery in elderly patients with hypertensive basal ganglia intracerebral hemorrhage

目的了解老年高血压基底节区脑出血患者微创术后短期预后情况,并分析危险因素。方法回顾性分析2016年6月—2021年2月铜陵市人民医院和铜陵市立医院收治的96例老年高血压基底节区脑出血患者的临床资料,根据预后结局的不同将患者分为预后良好组(n=34)及预后不良组(n=62),比较两组的临床资料,如:性别、年龄、基础病情况(高血压病年限、糖尿病)、入院时GCS评分、入院时动脉收缩压、入院时血糖、脑实质出血量、是否术前1 h内有复查头颅CT、是否有脑室出血、术后并发症(肺部感染、颅内感染、再出血),术后1个月GOS评分。正态分布的计量资料采用均数±标准差(±s)表示,组间比较采用独立t检验,计数资料组间比较采用χ^(2)检验,采用多因素Logistic回归分析筛选出入组患者微创术后短期预后独立危险因素。结果 96例入组患者中,单因素分析显示,两组在年龄、糖尿病、入院GCS评分、入院时动脉收缩压(SBP)、入院时血糖、术前1 h内复查头颅CT、脑室出血、手术时机、术后并发症数量的比较,差异具有统计学意义(P<0.05)。多因素Logistic回归分析显示,年龄>75岁(OR=4.358,95%CI:1.209~15.710)、糖尿病(OR=4.637,95%CI:1.793~11.990)、入院GCS评分≤8分(OR=14.305,95%CI:2.694~75.950)、入院时血糖≥10.0 mmol/L(OR=3.229,95%CI:1.261~8.270)、术前1 h内未复查头颅CT(OR=9.423,95%CI:1.827~48.599)、伴有脑室出血(OR=12.109,95%CI:3.336~43.961)、手术时机>7 h(OR=6.234,95%CI:1.986~19.570)、术后并发症数量≥2种(OR=13.461,95%CI:3.624~49.999)是入组患者短期预后的危险因素(P<0.05)。结论微创治疗老年高血压基底节区脑出血患者可获得满意的临床结局,但是年龄>75岁、糖尿病、入院GCS评分≤8分、入院时血糖≥10.0 mmol/L、术前1 h内未复查头颅CT、伴有脑室出血、手术时机>7 h、术后并发症数量≥2种均是影响患者短期预后的独立危险因素,临床上需加强患者围手术期的管理规范对改善预后具有重要意义。

Objective To investigate the short-term prognosis of elderly patients with hypertensive basal ganglia intracerebral hemorrhage after minimally invasive surgery and to analyze the risk factors.Methods The clinical data of 96 elderly patients with hypertensive basal ganglia intracerebral hemorrhage admitted to the Department of Neurosurgery of Tongling People′s Hospital and Tongling Municipal Hospital from June 2016 to February 2021.According to the difference of prognosis,the patients were divided into good prognosis group(n=34)and poor prognosis group(n=62).The clinical data of the two groups were compared.Such as sex,age,basic disease(years of hypertension,diabetes),GCS score at admission,arterial systolic blood pressure at admission,blood glucose at admission,volume of cerebral parenchyma hemorrhage,whether there was a reexamination of head CT within 1 hour before operation,whether there was intraventricular hemorrhage,postoperative complications(pulmonary infection,intracranial infection,rebleeding),GOS score 1 month after operation.The metrological data of normal distribution were expressed by mean±standard deviation(±s).Independent t test was used for comparison between groups.Chi-square test was used for comparison of counting data.Multivariate Logistic regression analysis was used to screen independent risk factors for short-term prognosis after minimally invasive surgery.Results Among the 96 patients,Univariate analysis showed that there were significant differences in age,diabetes,admission GCS score,arterial systolic blood pressure(SBP),blood glucose at admission,head CT within 1 hour before operation,intraventricular hemorrhage,timing of operation and number of postoperative complications between the two groups.Multivariate Logistic regression analysis showed that age>75 years old(OR=4.358,95%CI:1.209-15.710),diabetes mellitus(OR=4.637,95%CI:1.793-11.990),admission GCS score≤8(OR=14.305,95%CI:2.694-75.950),blood glucose≥10.0 mmol/L at admission(OR=3.229,95%CI:1.261-8.270),no reexamination of head CT within 1 hour before operation(OR=9.423,95%CI:1.827-48.599),intraventricular hemorrhage(OR=12.109,95%CI:3.336-43.961),operation time>7 hours(OR=6.234,95%CI:1.986-19.570),the number of postoperative complications≥2(OR=13.461,95%CI:3.624-49.999)were independent risk factors for short-term prognosis.Conclusions Minimally invasive treatment of elderly hypertensive basal ganglia intracerebral hemorrhage can achieve satisfactory clinical outcomes.However,age>75 years old,diabetes,admission GCS score≤8,blood glucose≥10.0 mmol/L at admission,no reexamination of head CT within 1 hour before operation,with intraventricular hemorrhage,operation time>7 hours,the number of postoperative complications≥2 are independent risk factors affecting short-term prognosis of patients.It is necessary to strengthen the perioperative management of patients,which is of great significance to improve the prognosis.