自发性脑出血30天病死率的预测方法研究  

Prognostic Methods for 30-day Mortality in Patients with Spontaneous Intracerebral Hemorrhage

作　　者：濮月华[1] 王拥军[1] 赵性泉[1] 柴锡庆[2] 艾青[3] 

机构地区：[1]首都医科大学附属北京天坛医院神经内科,北京市1100050 [2]河北化工医药职业技术学院 [3]北京垂杨柳医院神经内科

出　　处：《中国卒中杂志》2007年第6期475-481,共7页Chinese Journal of Stroke

摘　　要：目的探讨自发性脑出血30d预后的影响因素,建立预测模型,为临床诊治提供客观依据。方法回顾收集了300例自发性脑出血患者,对其临床及影像学特点进行详细的记录。通过单因素分析,找出与30d预后相关的指标,再进行多因素logistic回归分析,得出回归方程。结果Logistic回归分析筛选出5项影响30d病死率的独立预测因素,分别是:Glasgow昏迷量表(GCS)评分(x8,OR2.046,95%CI1.138～3.679)、美国国立卫生院卒中量表(NIHSS)评分(x15,OR2.590,95%CI1.226～5.470)、并发症(x16,OR4.820,95%CI1.877～12.377)、吞咽障碍(x17,OR7.912,95%CI1.280～48.901)和中线移位(x22,OR13.969,95%CI4.760～40.990)。回归方程为:Logit(p)=-12.005+0.716x8+0.952x15+1.573x16+2.068x17+2.637x22,该模型的判断正确率为87.3%。结论GCS评分、NIHSS评分、并发症、吞咽障碍和中线移位可作为判断自发性脑出血患者30d病死率的重要预测因素。Objective To explore the prognostic factors and model of early outcome(30-day mortality) in patients with spontaneous intracerebral hemorrhage(SICH). Methods We prospectively collected the clinical data of 300 consecutive patients admitted for SICH. Univariate and multiple logistic regression analyses were performed to determine independent predictors and prognostic model of early mortality. Results There were five significant and independent predictors of early mortality,Glasgow Coma Scale(GCS) score(X8,OR 2.046,95%CI 1.138-3.679),National Institutes of Health Stroke Scale(NIHSS) score(X15,OR 2.590,95%CI 1.226-5.470),complications(X16,OR 4.820,95%CI 1.877-12.377),dysphagia(X17,OR 7.912,95%CI 1.280-48.901),and midline shifting(X22,OR 13.969,95%CI 4.760-40.990). The prognostic model was Logit(P)=-12.005 + 0.716X8 + 0.952X15 + 1.573X16+2.068X17 + 2.637X22,with correct rate 87.3%. Conclusion GCS score,NIHSS score,complications,dysphagia,and midline shifting are important predictors of early mortality in patients with SICH.

关 键 词：脑出血 死亡率 影响因素 预测模型 

分 类 号：R743.3[医药卫生—神经病学与精神病学]