影响原发性脑桥出血患者预后的危险因素分析  

Risk factors analysis of outcomes for patients with primary pontine hemorrhage

作　　者：黄凯滨[1] 姬仲[1] 吴永明[1] 王胜男[1] 林镇洲[1] 潘速跃[1] 

机构地区：[1]南方医科大学南方医院神经内科,广东广州510515

出　　处：《中国危重病急救医学》2012年第5期274-277,共4页Chinese Critical Care Medicine

基　　金：广东省自然科学基金项目（1001510510100053）

摘　　要：目的探讨影响原发性脑桥出血患者预后的危险因素。方法回顾性分析广州市南方医院神经内科收治的60例原发性脑桥出血患者的病历资料，根据发病30d的存活情况分为存活组（34例）和死亡组（26例）。分别对患者的相关临床数据和影像学特点进行单因素和多元logistic回归分析，对多元logistic回归分析结果有统计学意义的连续性变量进行受试者工作特征曲线（ROC曲线）分析，判定其截断值。结果60例原发性脑桥出血患者30d病死率为43．3％。单因素分析结果显示，人院时格拉斯哥昏迷评分（GCS）、体温、心率、出血量、是否使用呼吸机辅助呼吸、血肿是否破入脑室、血肿部位与原发性脑桥出血患者30d病死率有关。多元logistic回归分析显示，人院时GCS评分[优势比（OR）=0．745，95％可信区间（95％CI）为（0．585，0．949）]、出血量[OR=1．438，95％CI（1．077，1．919）]以及血肿部位[基底-被盖型，OR=O．120，95％CI（0．016，0．904）]为影响原发性脑桥出血预后的独立危险因素（均P〈0．05）。ROC曲线分析显示，入院时GCS评分及出血量的截断值分别为7．5分和5．5ml。结论原发性脑桥出血患者血肿位于基底一被盖部、入院时GCS评分〈7．5分、出血量≥5．5ml者提示30d预后不良。Objective To evaluate the risk factors of prognosis in patients with primary pontine hemorrhage. Methods A retrospective analysis was conducted using data from 60 patients admitted with a diagnosis of primary pontine hemorrhage to the Department of Neurology of Nanfang Hospital in Guangzhou City. Patients were classified as survivors （n=34） and non-survivors （n=26） according to their outcomes on 30 days from the onset of symptoms. Univariate analysis and multivariate logistic regression analysis were performed on clinical data and imaging features of patients. Receiver operating characteristic curve （ROC curve） analysis was used on continuous parameters verified by multivariate logistic regression analysis to determine their cut-off value. Results The 30-day mortality was 43.3% for 60 patients with primary pontine hemorrhage. Univariate analysis showed Glasgow coma scale （GCS） at admission, temperature, heart rate, hemorrhage volume, mechanical ventilation, involvement of ventricles and location of hematoma were statistically related to 30-day mortality in patients with primary pontine hemorrhage. Multivariate logistic regression analysis demonstrated that the GCS at admission [odds ratio （OR） =0.745, 95% confidence interval （95%CI） 0.585 to 0.949], hemorrhage volume （OR=1.438, 95%CI 1.077 to 1.919） and location of hematoma （basal-tegmental hemorrhage, OR = 0.120, 95% CI 0.016 to 0.904 ） were independent risk facto~ of poor prognosis in patients with primary pontine hemorrhage （all P〈0.05 ）. ROC curve analysis showed the cut-off value for GCS score at admission and hemorrhage volume was 7.5 and 5.5 ml, respectively. Conclusion Patients suffering from primary pontine hemorrhage in the basal-tegmental region, GCS〈7.5 at admission and hemorrhage volume t〉5.5 ml would lead to a poor outcome in 30 days.

关 键 词：脑桥出血 原发性 危险因素 格拉斯哥昏迷评分 出血量 多元LOGISTIC回归 受试 者工作特征曲线 

分 类 号：R743.3[医药卫生—神经病学与精神病学]