CT征象预测原发性脑干出血患者意识障碍程度的价值  

Predictive value of CT signs for disorders of consciousness in patients with primary brainstem hemorrhage

作　　者：刘国芳 孙娟 陈珍珍 左诗怡 张磊 黄文杰 张冬 胡志安[3] 刘勇 姚忠祥[3] LIU Guofang;SUN Juan;CHEN Zhenzhen;ZUO Shiyi;ZHANG Lei;HUANG Wenjie;ZHANG Dong;HU Zhi’an;LIU Yong;YAO Zhongxiang(Department of Radiology,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037;Department of Pain and Rehabilitation,Second Affiliated Hospital,Army Medical University(Third Military Medical University),Chongqing,400037;Department of Physiology,College of Basic Medical Sciences,Army Medical University(Third Military Medical University),Chongqing,400038,China)

机构地区：[1]陆军军医大学(第三军医大学)第二附属医院:放射科,重庆3400037 [2]陆军军医大学(第三军医大学)第二附属医院疼痛与康复医学科,重庆3400037 [3]陆军军医大学(第三军医大学)基础医学院生理学教研室,脑与智能研究院,重庆400038

出　　处：《第三军医大学学报》2021年第15期1437-1443,共7页Journal of Third Military Medical University

基　　金：国家自然科学基金创新研究群体项目(31921003)。

摘　　要：目的分析CT征象对原发性脑干出血患者意识障碍程度的预测价值。方法收集2011年8月至2020年10月陆军军医大学第二附属医院收治的377例脑干出血患者,筛选出107例原发性脑干出血患者,按意识障碍程度分为神志清醒、嗜睡、昏睡、昏迷4个等级,先使用Mann-Whitney U检验与Spearman相关性分析对可能影响意识障碍程度的因素(性别、年龄、CT征象、出血分期)进行单因素分析,对具有统计学意义的因素再行有序多分类Logistic回归分析,探讨其与意识障碍程度的关系,寻找预测意识障碍程度的CT征象。结果 Mann-Whitney U检验提示性别与意识障碍程度无显著相关,而脑干出血是否破入脑室、是否累及中脑与意识障碍程度显著相关。Spearman相关性分析发现年龄与意识障碍程度无显著相关,而出血分期、出血平均CT值与意识障碍程度呈弱相关,出血形态差异性、密度异质性与意识障碍程度呈中等强度相关,出血量及血肿横断位最长径线与意识障程度呈强相关。进一步对单因素分析与意识障碍程度有统计学意义的因素进行有序多分类Logistic回归分析提示:(1)脑干出血患者出血量越多或血肿横断位最长径越长,意识障碍程度越严重;(2)脑干出血量>5-10 mL患者意识障碍程度至少加重一级的可能性是≤2 mL患者的8.05倍;血肿横断位最长径线>3-4 cm患者意识障碍程度至少加重一级的可能性是≤2 cm患者的16.66倍;(3)出血形态差异性、密度异质性、出血是否累及中脑、是否破入脑室与意识障碍程度无显著相关。结论原发性脑干出血患者出血量和血肿横断位最长径线长度与意识障碍程度呈正相关,且当脑干出血量>5-10 mL或血肿横断位最长径线>3-4 cm时能提示意识障碍程度等级变化。Objective To analyze the value of CT signs in the prediction of disorders of consciousness(DOC)in patients with primary brainstem hemorrhage(PBH).Methods A total of 377 patients with brainstem hemorrhage admitted to the Second Affiliated Hospital of Army Medical University from August 2011 to October 2020 were recruited,and 107 patients with PBH were screened out.According to the level of their consciousness,they were divided into 4 levels,that is,consciousness,somnolence,sopor and coma.Mann-Whitney U and Spearman rank correlation tests were used to perform univariate analysis on the factors that may affect DOC(gender,age,CT signs,bleeding stage),and ordinal multinomial logistic regression analysis was carried out for those with significance(P<0.05)to explore the correlation of these indicators with consciousness level in order to explore the CT signs that can predict the level of DOC.Results Mann-Whitney U test showed that gender had no significant correlation with DOC,while whether being broken into the ventricle or involved in the midbrain were significantly correlated.Spearman rank correlation analysis indicated that age was not significantly related with DOC,while bleeding stages and average CT values were weakly correlated with DOC,differences of shape and heterogeneity of density were moderately correlated with DOC,and bleeding volume and greatest hemorrhage diameter were highly correlated with DOC.Ordinal multinomial logistic regression analysis showed that:(1)The greater bleeding volume or the greatest hemorrhage diameters of the hematoma are,the more serious DOC in PBH patients is.(2)The probability of aggravating the DOC level in patients with>5~10 mL brainstem bleeding was 8.05 times higher than that in patients with≤2 mL bleeding volume.The patients with greatest hemorrhage diameters of>3~4 cm in hematoma had the possibility of aggravating the DOC level at least 1 grade,which was 16.66 times higher than those with≤2 cm.(3)There were no significant correlations among DOC and the differences of sha

关 键 词：原发性脑干出血 CT征象 意识障碍 预测 出血量 血肿横断位最长径线 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R749.13[医药卫生—临床医学]