高血压脑出血病人神经内镜血肿清除术后预后不良发生率及相关因素分析

Analysis on the incidence rate and related factors of poor prognosis in hypertensiveintracerebral hemorrhage patients after neuroendoscopic hematoma removal

目的:观察神经内镜血肿清除术治疗高血压脑出血(hypertensive intracerebral hemorrhage,HICH)病人的预后不良发生率及相关危险因素。方法:回顾性分析接受神经内镜手术治疗的152例HICH病人临床资料,均获得超过12个月随访。根据术后1年Barthel指数(BI)将病人分为预后良好组(BI>60分)98例和预后不良组(BI≤60分)54例。比较2组病人年龄、性别、格拉斯哥昏迷评分(GCS)、是否发生中线偏移、术前出血量、出血部位、手术时机、手术时间、脑脊液循环通畅时间、术后颅内压、血肿清除率、术前合并症进,并采用logistic回归分析探讨神经内镜术后预后不佳的危险因素。结果:单因素分析显示,预后良好组术前出血量、发生中线偏移率、手术时机在晚期比例和脑脊液循环通畅时间均少于预后不良组(P<0.05~P<0.01),GCS评分和血肿清除率均高于预后不良组(P<0.05和P<0.01)。Logistic回归分析结果显示,术前出血量多(OR=1.638)、GCS评分低(OR=0.612)、手术时机晚(OR=2.750)和发生中线偏移(OR=3.677)均为HICH病人神经内镜术后预后不良的独立危险因素(P<0.05~P<0.01)。结论:HICH病人神经内镜术前可通过缩短病人等待时间和减少出血量来提高预后效果。

Objective:To observe the incidence rate and related risk factors of poor prognosis in hypertensive intracerebral hemorrhage(HICH)patients treated with neuroendoscopic hematoma removal.Methods:The clinical data of 152 HICH patients treated with neuroendoscopic hematoma removal were retrospectively analyzed,and the patients were followed up for more than 12 months.According to the Barthel index(BI)at 1 year after surgery,the patients were divided into the good prognosis group(98 cases,BI>60 points)and bad prognosis group(54 cases,BI≤60 points).The age,gender,Glasgow coma score(GCS),midline deviation,preoperative blood loss,bleeding site,operation timing,operation time,cerebrospinal fluid circulation patency time,postoperative intracranial pressure,hematoma clearance rate,and preoperative complicated with chronic diseases were compared between two groups,and the logistic regression analysis was used to explore the risk factors of poor prognosis after neuroendoscopic surgery.Results:The results of single factor analysis showed that the preoperative blood loss,midline deviation rate,proportion of operation time in late stage and time of cerebrospinal fluid circulation patency in good prognosis group were lower than those in poor prognosis group(P<0.05 to P<0.01),and the GCS score and hematoma clearance rate in good prognosis group were higher than those in poor prognosis group(P<0.05 and P<0.01).The results of logistic regression analysis showed that the high preoperative blood loss(OR=1.638),low GCS score(OR=0.612),late operation time(OR=2.750)and midline deviation(OR=3.677)were the independent risk factors of poor prognosis in HICH patients after neuroendoscopic surgery(P<0.05 to P<0.01).Conclusions:The preoperative neuroendoscopy in HICH patients can improve the outcome through shortening the waiting time and reducing the amount of blood loss.