自发性幕上脑出血30d死亡的危险因素_医学论文.docVIP

自发性幕上脑出血30d死亡的危险因素_医学论文 自发性幕上脑出血30d死亡的危险因素_医学论文 作者：王洪典，江文，万琪，尚磊 【关键词】 脑出血 　　关键词: 脑出血死亡率危险因素Logistic模型 中图号:R743.34 文献标识码:A 　　摘 要:目的 探讨自发性幕上脑出血30d死亡的危险因素，建立脑出血30d生存或死亡的概率预测模型. 方法 回顾性分析我院近5a来病房收治的421例自发性幕上脑出血病例，对影响脑出血死亡的危险因素进行统计学分析. 结果 421例自发性幕上脑出血病人，30d死亡率为13.1%.单因素χ2 检验表明，意识障碍、脑出血破入脑室、大出血量、伴发糖尿病、缺血性心脏病、消化道出血等6个因素为自发性幕上脑出血30d死亡的危险因素（0.05）.多因素Logistic回归分析发现，仅有意识水平（OR=5.09，0.01）和出血量（OR=2.55，0.01）是脑出血30d死亡的独立的预测因子.脑出血30d死亡的概率预测模型为P=1/［1+e-（-4.842+1.663×意识水平+0.915×出血量） ］，该模型对脑出血30d死亡或生存预测总的正确率为90.5%. 结论 意识水平和出血量是影响自发性幕上脑出血30d死亡的最重要的危险因素. 　　Keywords:cerebral hemorrhagemortalityrisk factorslo-gistic models 　　Abstract:AIM To determine the most important predictors of30-day mortality in patients with spontaneous supratento-rial hemorrhage and to develop a predictive model of estimat-ing30-day mortality.METHODS Medical records and CT scans of421inpatients with spontaneous supratentorial hem-orrhage were respectively reviewed.Independent predictors of30-day mortality were determined by using univariate and multivariate statistical analysis.RESULTS Thirty days mortality for421cases of spontaneous supratentorial hemor-rhagewas13.1%.Univariate analysis found that initial level of consciousness，ventricular spreading of hemorrhage，hem-orrhage size，concomitant gastro-intestinal bleeding，diabetes mellitus and ischemic heart disease were significantly corre-lated with30-day mortality（0.05）.However multivari-ate logistic regression analysis showed that initial level of consciousness（OR=5.09，0.01）and hemorrhage size（OR=2.55，0.01）were the significant independent pre-dictors.Using these two catagories variables，the resulting model，P=1/［1+e -（-4.842+1.663×consciousness+0.915×hem-orrhage size） ］，can predicted30-day death or survival with an overall exact-ness of90.5%.CONCLUSION Initial level of conscious-ness，in combination with hemorrhage size，was a powerful and ease-to-use predictor of30-day mortality in patients with spontaneous supratentorial hemorrhage. 　　0 引言 　　自发性幕上脑出血