高血压脑出血患者血肿清除术后认知功能障碍的相关因素  

Related factors for cognitive dysfunction after hematoma removal surgery for hypertensive intracerebral hemorrhage

作　　者：李海杰 谭富强 司徒嘉欣 LI Haijie;TAN Fuqiang;SITU Jiaxin(Brain Hospital Affiliated to Guangzhou Medical University,Guangzhou 510160,China)

机构地区：[1]广州医科大学附属脑科医院,广东广州510160

出　　处：《中国实用神经疾病杂志》2024年第6期674-679,共6页Chinese Journal of Practical Nervous Diseases

摘　　要：目的探讨高血压脑出血(HICH)患者血肿清除术后认知功能障碍的相关因素。方法回顾性分析广州医科大学附属脑科医院2019-06—2023-06采用脑血肿清除术治疗的高血压脑出血患者的临床资料,以术后发生认知功能障碍(CD)的30例患者作为CD组,根据CD组患者的年龄、性别,按1∶2比例采用倾向匹配法从术后未发生CD的患者中筛选60例患者纳入无认知功能障碍(NCD)组。比较2组患者一般资料,将其中有统计学差异的因素代入Logistic分析,探索术后发生CD的相关因素(危险因素或保护因素)。各项相关因素采用概率法拟合构建风险模型,以受试者工作特征(ROC)曲线分析各危险因素与风险模型对HICH血肿清除术后CD发生的预测价值,计算诊断临界(cut-off)值。结果2组患者术中MAP均值、BIS均值与术后24hS100β、NSE、SOD水平比较,差异有统计学意义(P<0.05)。术中高MAP、BIS均值及术后24h高SOD水平为HICH血肿清除术后CD发生的保护因素(OR<1,P<0.05),术后24hS100β、NSE水平较高为CD发生的危险因素(OR≥1,P<0.05)。术中MAP均值≤89.815mmHg、术中BIS均值≤55.550、S100β≥1.957g·L^(-1)、NSE≥34.765g·L^(-1)、SOD≤67.865U·L^(-1)对于HICH血肿清除术后CD发生均具有中等预估价值(0.7<AUC≤0.9,P<0.05),据此构建的风险模型对于HICH血肿清除术后CD发生率具有较高预估价值(AUC>0.9,P<0.05)。结论术后24h高SOD水平为HICH血肿清除术后发生CD的保护因素,术后24hS100β、NSE水平较高为CD发生的危险因素,据此完善围术期检查及术中干预措施有利于降低高血压脑出血患者血肿清除术后认知功能障碍的发生概率。Objective To investigate the related factors for cognitive dysfunction after hematoma removal surgery for hypertensive intracerebral hemorrhage(HICH).Methods A retrospective analysis was conducted on the data of HICH patients treated by stereotactic soft channel minimally invasive brain hematoma removal surgery in the Brain Hospital Affiliated to Guangzhou Medical University from June 2019 to June 2023.Among them,30 patients who developed cognitive impairment(CD)after surgery were selected as the CD group.Based on the age and gender of the CD group,60 patients who did not develop CD after surgery were selected and included in the NCD group using propensity matching method in a 1∶2 ratio.The general information of two groups were compared,and the factors with statistical differences were substituted into Logistic analysis to identify the relevant factors(risk factors or protective factors)for postoperative CD occurrence.The probability method was used to fit various related factors and construct a risk model.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of each risk factor and risk model for the occurrence of CD after HICH hematoma removal surgery,and the cut-off value of diagnosis was calculated.Results Mean intraoperative MAP,mean intraoperative BIS,and the levels of S100β,NSE and SOD postoperative 24 hours in both groups had statistical differences(P<0.05).The higher mean intraoperative MAP,higher mean intraoperative BIS,and higher postoperative SOD levels in both groups are protective factors for postoperative CD occurrence in HICH hematoma removal surgery(OR<1,P<0.05).Higher S100βand NSE postoperative 24 hours are risk factors for CD occurrence after HICH hematoma removal surgery(OR≥1,P<0.05).Mean intraoperative MAP≤89.815 mmHg,mean intraoperative BIS≤55.550,S100β≥1.957 g/L,NSE≥34.765 g/L,SOD≤67.865 U/L had moderate predictive value for postoperative CD occurrence in HICH hematoma removal surgery(0.7<AUC≤0.9,P<0.05),and the risk model constructed b

关 键 词：高血压脑出血 血肿清除术 认知功能障碍 颅内血肿清除术 保护因素 危险因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]