自发性小脑出血术后远期预后影响因素分析  

Analysis of influencing factors of long⁃term prognosis after surgery for spontaneous cerebellar hemorrhage

作　　者：赵顺忠 杨彦龙 杨阳 鲁华山 朱宗远 张明浩 李立宏 ZHAO Shun-zhong;YANG Yan-long;YANG Yang;LU Hua-shan;ZHU Zong-yuan;ZHANG Ming-hao;LI Li-hong(Department of Emergency,the Second Affiliated Hospital of Air Force Military Medical University,Xi'an 710038,Shaanxi,China;Rocket Army Guangzhou Special Service Recuperation Centre,Guangzhou 510515,Guangdong,China;Department of Internal Medicine,the 63710 Military Hospital of Chinese PLA,Xinzhou 036301,Shanxi,China)

机构地区：[1]空军军医大学第二附属医院急诊科,西安710038 [2]火箭军广州特勤疗养中心,510515 [3]解放军六三七一○部队医院内科,忻州036301

出　　处：《中国现代神经疾病杂志》2022年第10期871-878,共8页Chinese Journal of Contemporary Neurology and Neurosurgery

基　　金：陕西省重点研发计划项目(项目编号:2017ZDXM⁃SF⁃042)。

摘　　要：目的探讨自发性小脑出血患者术后远期预后相关影响因素。方法纳入2012年1月至2019年9月空军军医大学第二附属医院收治的121例自发性小脑出血患者,术后12个月采用改良Rankin量表(mRS)评估预后,单因素和多因素逐步法Logistic回归分析筛查术后预后不良影响因素。结果预后不良组(mRS评分4~6分,79例)患者年龄(P=0.001)、GCS评分≤8分比例(P=0.000)、活化部分凝血活酶时间(P=0.003)、随机血糖水平(P=0.044)和呼吸机辅助通气比例(P=0.015)均高于预后良好组(mRS评分0~3分,42例),血小板计数低于预后良好组(P=0.017),两组手术方式差异亦有统计学意义(P=0.001)。Logistic回归分析表明,高龄(OR=1.090,95%CI:1.032~1.151;P=0.002)、血清高D⁃二聚体水平(OR=1.339,95%CI:1.034~1.735;P=0.027)、手术方式之开颅血肿清除术(OR=4.949,95%CI:1.310~18.691;P=0.018)和血肿穿刺引流术(OR=6.789,95%CI:1.249~36.912;P=0.027)是自发性小脑出血术后远期预后不良的主要危险因素。结论高龄、血清高D⁃二聚体水平和手术方式之开颅血肿清除术、血肿穿刺引流术是自发性小脑出血术后远期预后不良的危险因素。Objective To explore the influencing factors of long⁃term prognosis of patients with spontaneous cerebellar hemorrhage(SCH)after surgery.Methods Total 121 patients with SCH admitted to the Second Affiliated Hospital of Air Force Military Medical University from January 2012 to September 2019 were included.The prognosis was assessed by the modified Rankin Scale(mRS)12 months after surgery,and the risk factors related to dismal prognosis were screened by univariate and multivariate Logistic regression analysis.Results The age(P=0.001),proportion of Glasgow Coma Scale(GCS)score≤8(P=0.000),activated partial thromboplastin time(P=0.003),random blood glucose level(P=0.044)and ventilator assisted ventilation ratio(P=0.015)of patients with poor prognosis(mRS score 4-6,n=79)were higher than those of patients with good prognosis(mRS score 0-3,n=42),while platelet count was lower than those of patients with good prognosis(P=0.017).There was significant difference in surgery modes between 2 groups(P=0.001).Logistic regression analysis showed that older age(OR=1.090,95%CI:1.032-1.151;P=0.002),high serum D⁃dimer level(OR=1.339,95%CI:1.034-1.735;P=0.027),craniotomy hematoma removal(OR=4.949,95%CI:1.310-18.691;P=0.018)and hematoma puncture drainage(OR=6.789,95%CI:1.249-36.912;P=0.027)were the main risk factors for long⁃term dismal prognosis after surgery for SCH.Conclusions Older age,high serum D⁃dimer level and surgery modes are the risk factors for long⁃term dismal prognosis after surgery for SCH.

关 键 词：脑出血 小脑 神经外科手术 预后 危险因素 LOGISTIC模型 

分 类 号：R651.12[医药卫生—外科学]