自发性脑出血患者术后不良预后的危险因素及其预测价值  

Risk factors and predictive value of postoperative poor outcomes in patients with spontaneous intracerebral hemorrhage

作　　者：胡海成[1] 王如海 韩超[1] 于强[1] 黄好峰 李习珍 Hu Haicheng;Wang Ruhai;Han chao;Yu Qiang;Huang Haofeng;Li Xizhen(Department of Neurosurgery,Fuyang Fifth People′s Hospital,Fuyang 236063,China)

机构地区：[1]阜阳市第五人民医院神经外科,安徽236063

出　　处：《中华神经外科杂志》2020年第10期1057-1062,共6页Chinese Journal of Neurosurgery

摘　　要：目的探讨自发性脑出血(SICH)患者术后不良预后的危险因素及其对预后的预测价值。方法回顾性分析2015年1月至2019年6月阜阳市第五人民医院神经外科采用手术治疗的325例成人SICH患者的临床资料,均为能获得6个月随访者。采用单因素和多因素logistic回归分析法分析影响患者术后6个月预后的相关危险因素;采用受试者工作特征曲线(ROC)分析不同危险因素对预后的预测价值。结果325例患者中,术后6个月210例(64.6%)预后良好[格拉斯哥预后分级(GOS)Ⅳ~Ⅴ级],115例(35.4%)预后不良(GOSⅠ~Ⅲ级)。单因素logistic回归分析显示,年龄、脑室外引流、手术方式、脑疝、术前梗阻性脑积水、术前改良的Graeb评分(mGS),术前、术后格拉斯哥昏迷评分(GCS)、脑室内出血,术后中线移位、硬膜下积液、颅内感染及慢性脑积水是患者预后的可能影响因素(均P<0.05)。多因素logistic回归分析显示,年龄(OR=1.075,95%CI:1.041~1.110,P<0.001),术前mGS(OR=1.083,95%CI:1.010~1.162,P=0.026),术后中线移位(OR=2.716,95%CI:1.274~5.790,P=0.010)、颅内感染(OR=12.898,95%CI:2.225~74.760,P=0.004)、慢性脑积水(OR=3.665,95%CI:1.519~8.838,P=0.004)及GCS(OR=0.790,95%CI:0.649~0.961,P=0.018)是SICH患者术后不良结局的独立危险因素(均P<0.05)。年龄,术前mGS,术后中线移位、颅内感染、慢性脑积水及GCS预测不良预后的曲线下面积(AUC)分别为0.617(截断值为68岁)、0.674(截断值为11分)、0.654、0.532、0.705、0.798(截断值为8分),所有指标联合预测预后的AUC为0.875。结论高龄(>68岁),术前mGS评分(>11分),术后GCS(<8分)、中线移位、颅内感染及术后慢性脑积水是SICH患者术后预后不良的危险因素,联合应用可更好地预测患者的早期预后。Objective To investigate the risk factors of postoperative unfavorable outcomes in patients with spontaneous intracerebral hemorrhage(SICH)and to analyze their predictive value for prognosis.Methods The clinical and imaging data of 325 patients with adult SICH admitted to Department of Neurosurgery,Fuyang Fifth People′s Hospital from January 2015 to June 2019 were retrospectively analyzed.All patients were all followed up for 6 months.Univariate and multivariate logistic regression analysis were performed to study the relevant factors affecting the outcomes of postoperative patients at 6 months.The receiver operating characteristic(ROC)curves were applied to analyze the predictive value of risk factors for the prognosis.Results Among 325 SICH patients at 6 months post operation,210 cases(64.6%)had good outcomes[Glasgow Outcome Scale(GOS)Ⅳ-Ⅴ],115 cases(35.4%)had poor outcomes(GOSⅠ-Ⅲ).Univariate regression analysis showed that age,external ventricular drainage(EVD),type of surgery,cerebral hernia,pre-operative obstructive hydrocephalus,pre-and post-operative Glasgow Coma Scale(GCS),pre-and post-operative intraventricular hemorrhage(IVH),post-operative midline shift(MIS),subdural effusion,intracranial infection(ICI),the modified Graeb Scale(mGS)and chronic hydrocephalus(HCP)were possible influencing factors for outcomes(P<0.05).Multivariate binary logistic regression analysis revealed that age(OR=1.075,95%CI:1.041-1.110,P<0.001),pre-operative mGS(OR=1.083,95%CI:1.010-1.162,P=0.026),post-operative MIS(OR=2.716,95%CI:1.274-5.790,P=0.010),post-operative ICI(OR=12.898,95%CI:2.225-74.760,P=0.004),chronic hydrocephalus(OR=3.665,95%CI:1.519-8.838,P=0.004)and post-operative GCS score(OR=0.790,95%CI:0.649-0.961,P=0.018)were independent risk factors for poor outcomes.ROC curves showed that areas under the curve(AUC)of those independent influencing factors of poor outcomes were 0.617(68 years as the threshold for age),0.674(11 points as the threshold for mGS),0.654,0.532,0.705 and 0.798(8 points as the threshold for

关 键 词：脑出血 神经外科手术 预后 危险因素 预测 

分 类 号：R651.12[医药卫生—外科学]