影响高血压脑出血患者手术治疗后近期预后不良的危险因素

来源:用户上传      作者:胡慧慧 赵敬平 杨刚 钟玉婷

　　[摘要] 目的 探讨影响高血压脑出血（HICH）患者手术治疗后近期预后不良发生率及其相关危险因素。 方法 选取2019年1月至2020年12月浙江省诸暨市人民医院收治的182例HICH患者进行随访，依据术后3个月的预后情况，将其分为预后不良组（69例）和预后良好组（113例）;比较两组间年龄、性别、糖尿病、冠心病史、高血压病史、术前GCS评分、术前血肿量、出血部位、脑室积血、手术时机、手术方式、脑室外引流术、术后肺部感染、术后再出血、脑疝等因素分布;再采用多因素logistic回归法筛选影响HICH患者术后预后不良的相关危险因素。结果 182例HICH患者术后3个月的预后不良发生率为37.91%（69/182）;多因素logistic回w结果显示：影响HICH患者手术治疗后预后不良的危险因素包含年龄（OR=2.869）、术前GCS评分（OR=4.811）、术前血肿量（OR=3.536）、手术时机（OR=3.294）、开颅手术（OR=4.137）、术后肺部感染（OR=3.885）、术后再出血（OR=3.083）。结论 HICH患者术后近期预后不良发生率高达38%，且影响其近期预后不良的高危因素较多，应早期进行预防和治疗，降低预后不良发生率，改善HICH患者的预后。
　　[关键词] 高血压脑出血;手术;预后;危险因素
　　[中图分类号] R743.2 [文献标识码] B [文章编号] 1673-9701（2022）13-0038-04
　　[Abstract] Objective To explore the incidence of poor prognosis and its related risk factors in patients with hypertensive intracerebral hemorrhage （HICH） after surgical treatment. Methods A total of 182 HICH patients admitted to Zhuji People′s Hospital of Zhejiang Province from January 2019 to December 2020 were followed up. According to the prognosis after 3 months， they were divided into the poor prognosis group （69 cases） and the good prognosis group （113 cases）. The age， gender， diabetes， coronary heart disease history， hypertension history， preoperative GCS score， preoperative hematoma volume， bleeding site， intraventricular hemorrhage， operation opportunity， operation method， extraventricular drainage， postoperative pulmonary infection， postoperative rebleeding and cerebral hernia were compared between the two groups. Then， multivariate Logistic regression was used to screen the related risk factors affecting the poor postoperative prognosis of HICH patients. Results The incidence of poor prognosis of 182 patients with HICH 3 months after operation was 37.91% （69/182）. Multivariate Logistic regression showed that the risk factors affecting the poor prognosis of HICH patients after surgical treatment included age （OR=2.869）， preoperative GCS score （OR=4.811）， preoperative hematoma volume （OR=3.536）， surgical opportunity （OR=3.294）， craniotomy （OR=4.137）， postoperative pulmonary infection （OR=3.885） and postoperative rebleeding （OR=3.083）. Conclusion The incidence of short-term poor prognosis of HICH patients is as high as 38%， and there are many high-risk factors that affect their short-term poor prognosis. Early prevention and treatment should be carried out to reduce the incidence of poor prognosis and improve the prognosis of HICH patients.

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