接受立体定向微创穿刺治疗的急性脑出血患者预后的影响因素

Influencing factors on the prognosis of patients with acute cerebral hemorrhage undergoing stereotactic minimally invasive puncture

目的探究接受立体定向微创穿刺治疗的急性脑出血患者预后的影响因素。方法选取无锡市人民医院2019年11月—2021年4月收治的92例急性脑出血患者作为研究对象,均予以立体定向微创穿刺治疗,收集并整理患者的临床病历资料,分别对患者入院后24 h内的血常规指标[白细胞计数(WBC)及血肌酐(Scr)等]、影像学指标等进行检测,并根据患者术后2周影像学检查结果将其分为预后良好组和预后不佳组,以Logistic多因素回归分析探讨影响急性脑出血患者预后不佳的相关因素。结果92例入组患者中预后不佳组患者45例(48.91%),预后良好组47例(51.09%)。预后不佳组GCS评分低于预后良好组,脑疝、出血量>50 mL、合并硬膜外血肿所占比例及NIHSS评分均高于预后良好组(P<0.05)。Logistic多因素回归分析结果显示,GCS评分低、合并术前脑疝、出血量>50 mL、合并硬膜外血肿均为急性脑出血患者预后不佳的危险因素(P<0.05)。结论GCS评分低、NIHSS评分高、合并术前脑疝、出血量>50 mL、合并硬膜外血肿均影响急性脑出血患者立体定向微创穿刺术后的预后。

Objective To explore the factors affecting the prognosis of patients with acute cerebral hemorrhage receiving stereotactic minimally invasive puncture.Methods A total of 92 patients with acute cerebral hemorrhage underwent stereotactic minimally invasive puncture with in 24 hours after admission.Relevant clinical data,including scores of Glasgow Coma Scale(GCS)and National Institutes of Health Stroke Scale(NIHSS),were collected.Blood routine indicators[white blood cell count(WBC)and blood creatinine(Scr),etc.]were tested.Two weeks after surgery the patients were divided into 2 groups according to the prognosis:good prognosis group(n=47,51.09%)and poor prognosis group(n=41,48.91%).Logistic multivariate regression analysis was used to explore the related factors affecting the prognosis.Results The GCS score of the poor prognosis group was significantly lower than that of the good prognosis group,and the NIHSS score of the poor prognosis group was significantly higher than that of the good prognosis group(both P<0.05).The proportions of the patients with brain herniation,blood loss>50 mL,and combined with epidural hematoma in of the poor prognosis group were all significantly higher than those in the good prognosis group(all P<0.05).Logistic multivariate regression analysis showed that low GCS score,preoperative brain herniation,bleeding volume>50 mL and combinnation with epidural hematoma were all risk factors for poor prognosis in patients with acute cerebral hemorrhage(all P<0.05).Conclusion Low GCS score,high NIHSS score,preoperative brain hernia,bleeding volume>50 mL and combiation with epidural hematoma all affect the prognosis of patients with acute cerebral hemorrhage after stereotactic minimally invasive puncture.