临床神经外科杂志2019，Vol.16Issue(1)：54-58,5.DOI:10.3969/j.issn.1672-7770.2019.01.012
高血压基底节区出血合并脑疝患者开颅术后短期死亡风险预测
Risk prediction of short-term mortality after craniotomy in patients with hypertensive basal ganglia hemorrhage complicated with cerebral hernia
摘要
Abstract
Objective To investigate the preoperative factors that affect the short-term mortality of patients with hypertensive basal ganglia hemorrhage complicated with cerebral hernia undergoing craniotomy. Methods The clinical data of 41 patients with hypertensive basal ganglia hemorrhage complicated with hernia underwent early craniotomy with hematoma removal in addition to decompression surgery in the Department of Neurosurgery of the Third Affiliated Hospital of Soochow University from October 2014 to October 2017, were analyzed retrospectively. They were grouped according to whether they died within 30 days after surgery. Chi-square test was used in univariate analysis including age, gender, preoperative mean arterial pressure, preoperative GCS score, bleeding volume, midline deviation, hematoma morphology, ventricular hemorrhage, double pupil scattered ratioand so on. Meaningful variables were selected for multiple logistic regression analysis to evaluate the relationship between such factors and 30 days death of these patients. Results 18 cases died in 30 days after surgery among forty-one hypertensive basal ganglia hemorrhage complicated with cerebral hernia patients, the mortality rate was 43. 9％. There was no significant difference in clinical basal data between the two groups (all P＞ 0. 05) in age, gender, bleeding side, hematoma volumeand the timing of surgery. Univariate analysis showed that preoperative GCS score≤5, bilateral mydriasis, irregular hematoma morphology, significant central line shift, and severe ventricular hemorrhage were statistically significant for patients with short-term death (P ＜0. 05-0. 005). Multivariate logistic regression analysis showed that only the irregular hematoma morphology (OR = 0. 009, 95％ CI 0. 00-0. 458, P = 0. 019) and the lower GCS score (OR =50. 345, 95％ CI 1. 543-1642. 595, P = 0. 028) were the main factors affecting the death of patients after craniotomy. Conclusion The preoperative GCS score≤5 and the irregular shape of hematoma are the independent risk factors of postoperative death in patients with hypertensive intracerebral hemorrhage.关键词
高血压脑出血/脑疝/开颅手术/短期死亡/危险因素Key words
hypertensive intracerebral hemorrhage/hernia/craniotomy/short-term death/risk factor分类
医药卫生引用本文复制引用
祁海晖,杨伊林,赵卫祥,董博,毛宇敏,官卫..高血压基底节区出血合并脑疝患者开颅术后短期死亡风险预测[J].临床神经外科杂志,2019,16(1):54-58,5.基金项目
国家自然科学基金面上项目 (81870906) （81870906）
