重症高血压脑出血破入脑室患者术后慢性意识障碍的危险因素分析

doi:10.19854/j.cnki.1008-2425.2023.05.0006

摘要/Abstract

摘要： 目的探讨重症高血压脑出血(HICH)破入脑室患者术后形成慢性意识障碍(pDoC)的危险因素。方法回顾分析2020年7月至2023年1月阜阳师范大学附属第二医院收治的115例行手术干预的合并脑室出血HICH患者临床资料。根据术后28 d 意识障碍恢复情况将患者分为pDoC组(38例)和非pDoC组(77例)。使用改良的Graeb评分(mGS)评估脑室出血(IVH)严重程度。通过Logistic回归分析探讨pDoC形成的影响因素,采用受试者特征工作(ROC)曲线分析危险因素预测pDoC的能力。结果 115例患者中,38例发生pDoC,发生率为 33.0%。通过多因素Logistic回归分析,年龄(OR=1.110,95% CI:1.031~1.195,P=0.005))、格拉斯哥昏迷评分(GCS)(OR=0.495,95% CI:0.261~0.942,P=0.032)、mGS评分(OR=1.167,95% CI:1.019~1.335,P=0.025)、去骨瓣减压(OR=12.355,95% CI:1.979~77.133,P=0.007)、慢性脑积水(OR=6.565,95% CI:1.369~31.474,P=0.019)与pDoC的形成独立相关。经ROC曲线分析,上述危险因素预测pDoC的曲线下面积(AUC)分别为0.627(截断值66岁)、0.764(截断值5分)、0.740(截断值13分)、0.596、0.757,联合预测pDoC的AUC为0.918(95% CI:0.852~0.961,P＜0.001),敏感度84.4%,特异度92.1%。结论对于重症HICH破入脑室患者,年龄≥66岁、GCS评分≤5分、mGS评分≥13分、去骨瓣减压、慢性脑积水等因素是术后形成pDoC的危险因素。针对危险因素,临床应采取脑室外引流、腰椎穿刺、颅骨修补、脑室腹腔分流等相应干预措施,以改善预后。

关键词: 高血压脑出血, 慢性意识障碍, 改良的Graeb评分, 脑室出血, 神经外科手术

Abstract: Objective To investigate risk factors for prolonged disorders of consciousness in patients with severe hypertensive intracerebral hemorrhage rupturing into the ventricular system undergoing surgical treatment.Methods Clinical data of 115 patients with HICH rupturing into the ventricular system admitted to the Second Affiliated Hospital of Fuyang Normal Universityfrom July 2020 to January 2023 were retrospectively analyzed.The patients were divided into the group of pDoC (n=38) and the group of non-pDoC (n=77) according to the recovery of consciousness disorder at 28 days after surgery.The modified Graeb score (mGS) was used to assess the severity of intraventricular hemorrhage (IVH) secondary to HICH.By Logistic regression analysis,independent influencing factors for pDoC were detected.The receiver operating characteristic (ROC) curve was applied to analyze the predictive value of risk factors onpDoC.Results Of these 115 patients,38 patients suffered from pDoC,and the incidence rate was 33.0%.Multivariate binary logistic regression analysis showed that age(OR=1.110,95% CI:1.031~1.195,P=0.005)、Glasgow Coma Scal(GCS)(OR=0.495,95% CI:0.261~0.942,P=0.032)、modified Graeb Score(mGS) (OR=1.167,95% CI:1.019~1.335,P=0.025)、decompressive craniotomy(OR=12.355,95% CI:1.979~77.133,P=0.007)、chronic hydrocephalus (OR=6.565,95% CI:1.369~31.474,P=0.019) were independently correlated with pDoC.ROC curves showed the area under the curves(AUC)of those independent risk factors for pDoC were 0.627(66 years as the threshold for age),0.764 (5 points as the threshold for GCS),0.740(13 points as the threshold for mGS),0.596、0.757.The AUC of independent risk factors combined to predict pDoC was 0.918 (95%CI:0.852~0.961,P<0.001),the sensitivity was 84.4%,the specificity was 92.1%.Conclusion For patients with sever HICH rupturing into the ventricular system undergoing surgical treatment,age≥66 years,GCS score≤5分,mGS score≥13分,decompressive craniotomy and chronic hydrocephalus are risk factors for the formation of pDoC.According to the risk factors,clinical intervention measuressuch as external ventricular drainage,lumbar puncture,cranioplasty and ventriculoperitoneal shuntshould be taken to improve the patients' outcome.

Key words: Hypertensive intracerebral hemorrhage, Prolonged disorders of consciousness, Modified Graeb score, Intraventricular hemorrhage, Neurosurgical procedures

中图分类号:

曹祥记, 王如海, 李习珍, 李春, 孙菲琳, 杨震. 重症高血压脑出血破入脑室患者术后慢性意识障碍的危险因素分析[J]. 立体定向和功能性神经外科杂志, 2023, 36(5): 286-292.

Cao Xiangji, Wang Ruhai, Li Xizhen, et al. Risk factors for prolonged disorders of consciousness in patients with severe hypertensive intracerebral hemorrhage rupturing into the ventricular system undergoing surgical treatment[J]. Chinese Journal of Stereotactic and Functional Neurosurgery, 2023, 36(5): 286-292.

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