自发性小脑出血昏迷患者预后影响因素分析  

Factors related to prognosis of coma patients with spontaneous cerebellar hemorrhage

作　　者：陈祖鹏[1] 张昕[1] 黄李法[1] 李徐[1] 徐震[1] 竺国充[1] 

机构地区：[1]浙江中医药大学附属第一医院神经外科,杭州310006

出　　处：《浙江医学》2015年第22期1816-1819,共4页Zhejiang Medical Journal

摘　　要：目的分析自发性小脑出血昏迷患者的生存情况，探讨影响远期预后的相关因素。方法回顾性随访分析82例小脑出血后格拉斯哥评分（GCS）≤8分的患者，对研究对象10项基线特征进行生存分析，采用Kaplan—Meier法计算，单因素患者生存率比较采用log—rank检验，多因素分析采用Cox比例风险模型。结果随访期内死亡患者53例，4例失访，中位生存期（四分位数间距）为22．0（38．0）个月。单因素分析表明，原发性心脑血管事件（P=0013）、脑室积血（P=0019）和GCS评分≤5分（P=0013）为预后的危险因素。采用Cox比例风险模型进行多因素分析，同样表明原发性心脑血管事件（HR=1．959，95％CI1．082～3．545）、脑室积血（HR=2．019，95％CI 1．165～3.948）、GCS评分≤5分（HR=11813，95％CI 1．008—3．261）对生存率有显著影响。手术可以提高生存率和延长生存时间，但无统计学意义（P=0．812）。结论小脑出血昏迷患者的病死率仍较高，决定远期预后的影响因素为原发性心脑血管事件、脑室积血和GCS评分≤5分。Objective To investigate the clinical outcome and predictive factors in the coma patients with spontaneous cerebellar hemorrhage. Methods The clinical manifestations were recorded and analyzed in 82 patients suffering from cerebellar hemorrhage over a 6-year period. The level of consciousness was evaluated with Glasgow coma scale （GCS）. Outcome was assessed at least 2 years after onset. Kaplan-Meier survival curves were plotted and compared using log-rank tests. Cox regression model was used to analyze the effect of different variables on survival. Results Four patients lost follow up and 53 died, the median survival time （interquartile range） were 22.0 （38.0） months. Univariant analysis showed that primary card io-cerebrovascular events （P=0.013）, ventricular hemorrhage （P=0.019） and GCS ≤ 5 （P=0.013） were the significant negative predictors for the survival time. Cox regression model also showed that Primary cardio-cerebrovascular events（HR=1.959, 95%CI 1.082-3.545）, ventricular hemorrhage （HR=2.019, 95%CI：1.165-3.948） and GCS ≤5 （HR=1.813, 95% CI：1.008-3.261） were predictors for poor outcomes. Conclusion The mortality remains high in coma patients with spontaneous cerebellar hemorrhage, patients with primary cardio-cerebrovascular events, ventricular hemorrhage and GCS≤5 are in high risk of poor prognosis,

关 键 词：小脑出血 昏迷 中位生存期 生存分析 

分 类 号：R743.34[医药卫生—神经病学与精神病学]