脑出血患者预后的影响因素及饮酒对其影响

Prognostic Factors of Patients with Cerebral Hemorrhage and theInfluence of Alcohol Consumption

目的探讨脑出血患者预后的相关影响因素及重度饮酒对其影响。方法选取2019年10月至2021年8月南阳市卧龙区第一人民医院诊治的178例脑出血患者为研究对象,根据患者预后情况分为预后不良(40例)、预后良好(138例),分析患者预后的影响因素。并根据患者饮酒量分为重度饮酒组(68例)、中度饮酒组(52例)、不/轻度饮酒组(58例)。随访1~12个月,分析重度饮酒对脑出血疗效与生存的影响。结果多因素logistic回归分析显示,脑干出血、重度饮酒为脑出血患者预后不良的独立危险因素(OR=42.872、12.064,P<0.05),年龄<65岁、神经功能损伤评分(NDS)评分<30分、血肿体积<30 mL为脑出血患者预后不良的保护因素(OR=0.293、0.299、0.270,P<0.05)。广义估计方程分析显示:不/轻度饮酒组治疗有效率高于中度饮酒组及重度饮酒组(P<0.05)。随访12个月后,178例患者共40例(22.47%)发生预后不良,其中血肿扩大16例(8.99%),脑水肿13例(6.74%),术后再出血11例(6.18%)。Kaplan-Meier生存曲线分析显示,3组预后不良事件总发生率比较差异有统计学意义(P<0.05),且随饮酒量的增加,患者预后不良事件发生率增加。结论年龄、NDS评分、血肿体积、脑干出血、重度饮酒均可导致脑出血患者预后不良,且饮酒量越多,疗效越差,预后状态越差。

Objective To explore the prognostic factors of patients with cerebral hemorrhage and the influence of heavy drinking.Methods A total of 178 patients with cerebral hemorrhage diagnosed and treated in the First People’s Hospital of Wolong District of Nanyang from October 2019 to August 2021 were selected as the study objects.According to the prognosis of patients,they were divided into poor prognosis(40 cases)and good prognosis(138 cases).The influencing factors of patients’prognosis were analyzed.The patients were divided into heavy drinking group(68 cases),moderate drinking group(52 cases)and no/light drinking group(58 cases)according to their drinking volume.The patients were followed up for 1 to 12 months to analyze the effect of heavy drinking on the therapeutic efficacy and survival of bleeding.Results Multivariate logistic regression analysis showed that brain stem hemrrhage and heavy drinking were independent risk factor for poor prognosis of patients with cerebral hemorrhage(OR=42.872,12.064,P<0.05),and age<65 years old,nervous functional deficiency(NDS)score<30 points,hematoma volume<30 mL were protective factors for poor prognosis of patients with intracerebral hemorrhage(OR=0.293,0.299,0.270,P<0.05).The analysis of generalized estimation equation shows that the effective rate of treatment in the no/light drinking group was higher than that in the moderate drinking group and the heavy drinking group(P<0.05).After 12 months of follow-up,40 of 178 patients(22.47%)had poor prognosis,including 16 cases of hematoma expansion(8.99%),13 cases of brain edema(6.74%),and 11 cases of postoperative rebleeding(6.18%).Kaplan-Meier survival curve analysis showed a statistically significant difference in the overall incidence of prognostic adverse events in the three groups(P<0.05),and the incidence of prognostic adverse events in patients increased with increasing alcohol consumption.Conclusion Age,NDS score,hematoma volume,brain stem hemorrhage and heavy drinking all lead to the poor prognosis of patients with cerebral hemorrhage.The higher the amount of drinking,the worse the curative effect,and the worse the survival status.