入院时脑局部氧饱和度与高血压脑出血患者转归的相关性  

Correlation between regional cerebral oxygen saturalion at admission and outcomes in patients with hypertensive intracerebral hemorrhage

作　　者：丁昊[1] 邓琳[2] Ding Hao, Deng Lin(Deportment of Neurosurgery, Zigong Fourth People＇s Hospital, Zigong 643000, China ; Department of Neurology, Zigong Fourth People＇s Hospital, Zigong 643000, China)

机构地区：[1]自贡市第四人民医院神经外科,643000 [2]自贡市第四人民医院神经内科,643000

出　　处：《国际脑血管病杂志》2018年第6期439-443,共5页International Journal of Cerebrovascular Diseases

基　　金：四川省卫生计生委科研课题（140110）

摘　　要：目的 研究高血压脑出血患者入院时局部脑氧饱和度（regional cerebral oxygen saturation,rSO2）对患者转归的影响.方法 前瞻性纳入高血压脑出血患者,采用近红外光谱技术监测入院时rSO2,并收集各种基线资料.在发病后6个月采用改良Rankin量表评分评估临床转归,0～2分定义为转归良好,〉2分定义为转归不良.应用二元logistic回归分析确定临床转归的独立影响因素.结果 共纳入103例患者,男性67例,女性36例,平均年龄（64.41±11.70）岁;平均基线美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale,NIHSS）评分为（17.12±8.58）分,平均基线格拉斯哥昏迷量表（Glasgow Coma Scale,GCS）评分为（9.82±2.54）分;基底节外囊血肿66例,丘脑出血37例;血肿体积2～80 ml,平均为（26.53±18.94）ml;54例出血破入脑室;55例存在中线移位;70例（68.0％）转归良好,33例（32.0％）转归不良,其中12例（11.7％）死亡.转归良好组与转归不良组在年龄、血肿体积、基线NIHSS评分、基线GCS评分、入院时rSO2以及血肿破入脑室、中线移位、脑疝形成、行血肿清除术的患者构成比差异有统计学意义.多变量logistic回归分析显示,年龄较大[优势比（odds ratio,OR）1.124,95％ 可信区间（confidence interval,CI）1.035～1.221;P=0.005]、血肿体积较大（OR 1.158,95％CI 1.053～1.274;P=0.002）、基线NIHSS评分较高（OR 1.340,95％CI 1.093～1.642;P=0.005）和入院时rSO2较低（OR 2.212,95％CI 1.033～4.737;P=0.041）是患者发病后6个月时转归不良的独立危险因素.结论 入院rSO2与高血压脑出血患者转归不良相关.Objective To investigate the effect of regional cerebral oxygen saturation （rSO2 ） at admission on the outcomes in patients with hypertensive intracerebral hemorrhage.Methods Patients with hypertensive intracerebral hemorrhage were enrolled prospectively. Near-infrared spectroscopy was used to detect rSO2 at admission, and various baseline data were collected. Six months after onset, the clinical outcomes were assessed by the modified Rankin Scale scores, and 0-2 was defined as good outcome and 〉 2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent influencing factors for clinical outcomes. Results A total of 103 patients with hypertensive intracerebral hemorrhage were enrolled, including 36 females and 67 males （mean age 64. 41 ± 11. 70 years）. The mean baseline score of the National Institutes of Health Stroke Scale （NIHSS） was 17. 12 ±8. 58, the mean baseline Glasgow Coma Scale （GCS） score was 9. 82 ± 2. 54; 66 patients had basal ganglion hematoma, 37 had thalamus hemorrhage; hematoma volumes were 2-80 ml, mean 26. 53 ±18. 94 ml; hematoma extended into the ventricles in 54 patients, and 55 patients had midline shift; 70 （68. 0%） had good outcomes, and 33 （32. 0%） had poor outcomes, 12 （11. 7%） of them died. There were significant differences in age, hematoma volume, baseline NIHSS score, baseline GCS score, rSO2 at admission, and the proportions of hematoma extended into the ventricles, midline shift, brain herniation, received hematoma evacuation between the good outcome group and the poor outcome group. Multivariate logistic regression analysis showed that older age （odds ratio [OR] 1. 124, 95% confidence interval [CI] 1. 035-1. 221; P =0. 005）, larger hematoma volume （OR 1. 158, 95% CI 1. 053-1. 274; P =0. 002）, higher baseline NIHSS score （OR 1. 340, 95% CI 1. 093-1. 642; P = 0. 005）, and lower rSO2 at admission （OR 2. 212, 95% CI 1. 033-4. 737; P = 0. 041） were the independent risk factors for poor

关 键 词：脑出血 高血压 血氧测定法 光谱法 近红外线 治疗结果 

分 类 号：R743.34[医药卫生—神经病学与精神病学]