高血压性脑出血小骨窗开颅手术后继发性脑梗死的危险因素分析  

Analysis on risk factors of secondary cerebral infarction after small bone window craniotomy with hypertensive intracerebral hemorrhage

作　　者：程海鸥 唐乐乐 CHENG Hai-ou;TANG Le-le(Department of Neurosurgery,Huangshan Shoukang Hospital,Huangshan 245000,China)

机构地区：[1]黄山首康医院神经外科,黄山245000

出　　处：《临床神经外科杂志》2023年第1期99-103,共5页Journal of Clinical Neurosurgery

摘　　要：目的 探讨基于高血压性脑出血小骨窗开颅手术患者临床资料分析术后继发性脑梗死危险因素。方法 选取2018年1月—2020年1月于黄山首康医院就诊的行小骨窗开颅手术治疗的高血压性脑出血患者100例,随访1年,评估手术治疗效果。根据患者术后情况分为脑梗死组(27例)和无脑梗死组(73例),采用Logistic多因素回归分析影响患者术后继发性脑梗死的独立危险因素,建立XGBoost模型并验证。结果 高血压性脑出血患者经小骨窗开颅手术治疗1年后,患者的死亡概率(10.00%)显著低于存活概率(90.00%)(P<0.05)。Logistic多因素回归分析发现,高血压病史时间长、收缩压和舒张压大、血肿量大、水肿范围大、脑组织移位大、脑组织移位时间长、手术操作的不规范以及使用止血降颅压药物,均为患者术后继发性脑梗死的独立危险因素。XGBoost模型的一致性指数(C-index)和ROC的AUC分别为0.809和0.813,区分度尚可。内部验证校准图显示,预测情况与实际情况具有良好的一致性。结论 高血压性脑出血小骨窗开颅术后继发性脑梗死与高血压病史时间、血肿量、脑水肿、脑组织移位及时间、手术操作规范及止血降颅压药物的使用等因素有关,其中高血压病史时间长、收缩压和舒张压大是影响较高的危险因素。Objective To explore the risk factors of secondary cerebral infarction after craniotomy based on the clinical data of patients with hypertensive intracerebral hemorrhage(HICH). Methods A total of 100 patients with hypertensive cerebral hemorrhage who underwent small bone window craniotomy in Huangshan Shoukang Hospital from January 2018 to January 2020 were selected and followed up for 1 year to evaluate the effect of surgical treatment. The patients were divided into cerebral infarction group(27 cases) and non-cerebral infarction group(73 cases) according to their postoperative conditions, and logistic multivariate regression analysis was used to analyze the independent risk factors affecting patients with postoperative cerebral infarction. XGBoost model was established and verified. Results In patients with HICH, the probability of death(10.00%) was significantly lower than the probability of survival(90.00%)(P<0.05) after 1 year of treatment with small bone window craniotomy. Logistic multivariate regression analysis found that a long history of hypertension, high systolic and diastolic blood pressure, large hematoma, broad edema, sever brain tissue displacement, longer brain tissue displacement, nonstandard surgical procedures, and the use of hemostatic and dehydration drugs were independent risk factors for postoperative secondary cerebral infarction. The consistency index(C-index) of the XGBoost model and the AUC of the ROC were 0.809 and 0.813, respectively, and the discrimination was good and acceptable. The internal verification calibration chart showed that the predicted situation was in good agreement with the actual situation. Conclusions Secondary cerebral infarction after small bone window craniotomy for HICH is related to such factors as hypertension history time, hematoma volume, brain edema, brain tissue displacement and time, operation specification and use of hemostatic and intracranial pressure reducing drugs. Among them, a long history of hypertension, high systolic and diastolic blood pressu

关 键 词：脑出血 小骨窗开颅手术 脑梗死 LOGISTIC回归分析 XGBoost模型 

分 类 号：R651[医药卫生—外科学]