高血压基底节区出血合并脑疝患者开颅术后短期死亡风险预测  

Risk prediction of short-term mortality after craniotomy in patients with hypertensive basal ganglia hemorrhage complicated with cerebral hernia

作　　者：祁海晖 杨伊林[1] 赵卫祥 董博[1] 毛宇敏[1] 官卫[1] QI Hai-hui;YANG Yi-lin;ZHAO Wei-xiang(Department of Neurosurgery,the Third Affiliated Hospital of Soochow University,Suzhou 213003,China)

机构地区：[1]苏州大学附属第三医院神经外科,苏州213003

出　　处：《临床神经外科杂志》2019年第1期54-58,共5页Journal of Clinical Neurosurgery

基　　金：国家自然科学基金面上项目(81870906)

摘　　要：目的探讨影响高血压基底节区出血合并脑疝患者开颅手术治疗后短期死亡的术前因素。方法回顾性分析2014年10月—2017年10月苏州大学附属第三医院神经外科行开颅血肿清除联合去骨瓣减压术的41例高血压基底节区出血合并脑疝患者的临床资料。根据患者术后30 d预后分为生存组及死亡组。比较两组患者的年龄、性别、术前平均动脉压、手术时间、术前GCS评分、出血量、中线偏移程度、血肿形态、脑室出血、双瞳散大的比率。将单因素分析中有统计学意义的指标引入多元Logistic回归模型,分析影响患者30 d内死亡的术前危险因素。结果本组患者中,术后30 d死亡18例(43. 9%),存活23例。两组患者的年龄、性别、出血侧别、血肿量及手术时机比较,差异均无统计学意义(均P> 0. 05);而术前GCS评分≤5分、双侧瞳孔散大、血肿形态不规则、中线移位显著及脑室严重出血比率的差异均有统计学意义(P <0. 05～0. 005)。多因素Logistic回归性分析示,GCS评分≤5分(OR=50. 345,95%CI 1. 543～1 642. 595,P=0. 028)和血肿形态不规则(OR=0. 009,95%CI 0. 00～0. 458,P=0. 019)是影响患者术后30 d内死亡的术前危险因素。结论术前GCS评分≤5分及血肿形态不规则是高血压脑出血合并脑疝患者术后短期死亡的独立危险因素。Objective To investigate the preoperative factors that affect the short-term mortality of patients with hypertensive basal ganglia hemorrhage complicated with cerebral hernia undergoing craniotomy. Methods The clinical data of 41 patients with hypertensive basal ganglia hemorrhage complicated with hernia underwent early craniotomy with hematoma removal in addition to decompression surgery in the Department of Neurosurgery of the Third Affiliated Hospital of Soochow University from October 2014 to October 2017,were analyzed retrospectively. They were grouped according to whether they died within 30 days after surgery. Chi-square test was used in univariate analysis including age, gender, preoperative mean arterial pressure, preoperative GCS score,bleeding volume,midline deviation,hematoma morphology,ventricular hemorrhage,double pupil scattered ratioand so on. Meaningful variables were selected for multiple logistic regression analysis to evaluate the relationship between such factors and 30 days death of these patients. Results 18 cases died in 30 days after surgery among forty-one hypertensive basal ganglia hemorrhage complicated with cerebral hernia patients,the mortality rate was 43. 9%. There was no significant difference in clinical basal data between the two groups( all P > 0. 05) in age,gender,bleeding side,hematoma volumeand the timing of surgery. Univariate analysis showed that preoperative GCS score≤5,bilateral mydriasis,irregular hematoma morphology,significant central line shift,and severe ventricular hemorrhage were statistically significant for patients with short-term death( P <0. 05-0. 005). Multivariate logistic regression analysis showed that only the irregular hematoma morphology( OR = 0. 009,95% CI 0. 00-0. 458,P = 0. 019) and the lower GCS score( OR =50. 345,95% CI 1. 543-1642. 595,P = 0. 028) were the main factors affecting the death of patients after craniotomy. Conclusion The preoperative GCS score≤5 and the irregular shape of hematoma are the independent risk factors of postoperative

关 键 词：高血压脑出血 脑疝 开颅手术 短期死亡 危险因素 

分 类 号：R651.1[医药卫生—外科学]