手术治疗高血压基底核脑出血的预后因素分析附165例分析.docVIP

手术治疗高血压基底核脑出血的预后因素分析 （附165例分析） 　　作者：丁昊,游潮,邓琳,尹浩,王翔　　作者单位：四川大学华西医院神经外科， 四川 成都 610041 　　【摘要】目的 探讨手术治疗高血压基底核区脑出血的预后影响因素。 方法 回顾性分析165例高血压脑出血病人的临床资料。采取小骨窗微侵袭手术80例，常规开颅手术85例;超早期手术72例，非超早期手术93例。以近期病死率及术后6月ADL分级作为预后判断指标，采用多因素Logistic回归分析可能影响治疗效果的因素，如年龄、入院GCS评分、颅内血肿量、脑室积血程度、是否发生脑疝、手术时机、手术方式。 结果 单因素分析：小骨窗微侵袭手术组近期病死率 (17.0%) 与常规手术组 (22.4%) 差异无统计学意义，小骨窗微侵袭手术组远期恢复良好率 (60.0%) 显著性高于常规手术组 (42.4%);超早期手术组近期病死率 (11.1%) 显著性低于非超早期手术组 (26.9%)，远期恢复良好率 (63.9%) 显著性高于非超早期手术 (40.9%)。多因素分析：入院GCS评分、是否发生脑疝及手术时机对近期病死率有显著性影响，是否发生脑疝、手术时机及手术方式对远期恢复效果有显著性影响。 结论 超早期微侵袭手术方式可能是降低病死率，改善病人预后的适宜手术方案。 　　【关键词】 颅内出血，高血压性; 神经外科手术; 预后因素 　　Analysis of prognostic factors for surgery for hypertensive cerebral hemorrhage of the basal ganglia: 　　report of 165 cases 　　DING Hao1, YOU Chao1, DENG Lin2, et al. 　　1. Department of Neurosurgery, Huaxi Hospital of Sichuan University, Chengdu 610041, China; 2. Department of Neurology, 　　the Fourth Peoples Hospital of Zigong, Zigong 643000, China 　　Abstract: Objective To explore the factors influencing prognosis of surgery for hypertensive cerebral hemorrhage of the basal ganglia. Methods Clinical data of 165 patients with hypertensive cerebral hemorrhage were analyzed retrospectively. The minimally invasive surgery through small craniotomy was performed in 80 cases and traditional surgery in 85. Ultra-early surgery was performed in 72 cases and non-ultra-early surgery in 93. The outcome was evaluated by mortality within 1 month and activities of daily living scores 6 months after surgery. The Logistic regression analysis was used to evaluate the potential prognostic factors, such as age, GCS score, volume of intracranial hematoma, and occurrence of cerebroventricular hemorrhage, cerebral hernia, timing and methods of surgery. Results The single factor analysis showed that the mortality of minimally invasive surgery group was 17.0%, while traditional surgery group was 22.4%, and there was no significant difference between them. But the long-ter