ICH指数对急性脑出血患者预后的简易评估
发布时间：2018-10-05 19:28
【摘要】：目的急性脑出血是一种严重危害人类健康的常见病。目前的多项研究关于脑出血预后估测模型已经很多,脑出血预后模型的测评对于脑出血患者积极采取各种治疗手段、病情的交代上及医疗资源的合理利用上有着至关重要的作用,但目前预测脑出血(I CH)患者死亡率和功能预后的模型都必须结合高端设备仪器检查,费用比较贵,程序比较复杂,时效性比较慢。本研究建立并评估了一个简单、可靠、易行的、合理的、适用于各种大小医院快速预测脑出血预后的模型,即脑出血指数(I CHI),探讨其临床应用价值。 方法自2007年1月至2011年12月住院的急性脑出血病例。收集了共780例脑出血患者,分为脑出血存活组590例和脑出血死亡组190例(院内死亡的)。所有入选患者均记录临床基本资料,包括Age、Male.BP、Gu、ALT、高密度脂蛋白胆固醇、血细胞分析等)。运用SPSSl5.0统计软件处理分析,定性变量用率表示,基线特征比较采用t检验,以P0.05为差异有统计学意义。观察年龄、血糖、白细胞及GCS评分对脑出血预后的测评价值,进行Logi stic回归分析,评估各变量对脑出血住院死亡率的贡献大小 结果两组患者之间的性别比较,组间差异无统计学意义(P0.05)；两组患者之间的血压、血糖、ALT、高密度脂蛋白胆固醇、血细胞分析等基本资料比较,组间差异有统计学意义(P0.05)；而且年龄、血糖、白血细胞计数(WBC)、格拉斯哥昏迷评分(GCS)与脑出血的死亡率有极大的相关性。建立脑出血指数(I CH)的公式[I CHI=年龄(岁)/10+血清葡萄糖(mmol/L)+白细胞计数(109、L)—GCS评分]。并绘制受试者工作特征(ROC)曲线,评估I CHI的预测价值。结果显示ROC曲线面积(AURC)为0.797(95%可信区间为：0.762-0.832,P0.001)。脑出血指数对死亡率的最适值为18,脑出血指数对死亡率的敏感性、对死亡率的特异性、约登指数(Youden's i ndex)依次为0.637,0.800和0.437。与总体死亡率(24.39明相比,18I CHI27(死亡率45.56%)和I CHI27(死亡率62.86%)时住院死亡率明显增加。 结论院内死亡患者较存活患者Age偏大,G u、VBC计数偏高,脑出血后存活组患者的GCS评分比脑出血后死亡组偏高；并且经过Logi st i c回归分析后发现,这四项指标与脑出血预后有更为密切的关系。这符合临床上实际现象,即随着年龄的增大,体内各种应急反应的加重及危险评分偏低,脑出血患者的预后越差。检测以上指标,相比脑出血体积量的计算,有助于从更实际的角度出发评估脑出血患者的病情及预后程度,可能为临床合理有效诊断脑出血患者及其预后测评提供更为及时快速的简易预测手段。脑出血指数(1CHI)是一个简单的预测模型,对其他预测模型是一个补充。
[Abstract]:Objective Acute intracerebral hemorrhage (AICH) is a common disease that seriously endangers human health. There have been many models for estimating the prognosis of intracerebral hemorrhage in recent studies. The evaluation of prognosis models of cerebral hemorrhage has taken various treatment measures for patients with intracerebral hemorrhage. It is very important to account for the condition of the disease and to utilize the medical resources reasonably. However, the models for predicting the mortality and functional prognosis of (I CH) patients with intracerebral hemorrhage must be combined with high-end equipment, the cost is expensive and the procedure is more complicated. Timeliness is slow. This study established and evaluated a simple, reliable, feasible and reasonable model for predicting the prognosis of intracerebral hemorrhage (ICH) in various hospitals, I. e., intracerebral hemorrhage index (I CHI),). Methods from January 2007 to December 2011, patients with acute cerebral hemorrhage were hospitalized. A total of 780 patients with intracerebral hemorrhage were divided into two groups: intracerebral hemorrhage survival group (590 cases) and intracerebral hemorrhage death group (190 cases). All patients were enrolled to record basic clinical data, including Age,Male.BP,Gu,ALT, high density lipoprotein cholesterol, blood cell analysis, etc. SPSSl5.0 statistical software was used to process the analysis, the qualitative variable rate was expressed, and the baseline characteristics were compared with t test, with P0.05 as the difference. The value of age, blood glucose, white blood cell and GCS score on prognosis of intracerebral hemorrhage was observed. Logi stic regression analysis was performed to evaluate the contribution of various variables to the mortality rate of patients with intracerebral hemorrhage. There was no significant difference between the two groups (P0.05); there were significant differences in blood pressure, alt, HDL cholesterol, blood cell analysis between the two groups (P0.05); and age, blood sugar, White blood cell count (WBC), Glasgow coma score (GCS) was significantly correlated with ICH mortality. The formula of intracerebral hemorrhage index (I CH) was established [I CHI= age (years old) / 10 serum glucose (mmol/L) leukocyte count (109 L) GCS score]. The predictive value of I CHI was evaluated by drawing the (ROC) curve of the operating characteristics of the subjects. The results showed that the area of ROC curve (AURC) was 0.797 (95% CI = 0.762-0.832). The most suitable value of ICH index for mortality was 18. The sensitivity of ICH index to mortality and the specificity of ICH index to mortality were 0.6370.800 and 0.43770.800, respectively. Compared with the total mortality rate (24.39 Ming), the hospital mortality at 18 I CHI27 (mortality rate 45.56%) and I CHI27 (mortality rate 62.86%) increased significantly. Conclusion the number of Age in patients with death in hospital is higher than that in patients with survival. The GCS score of patients with intracerebral hemorrhage is higher than that of patients who die after intracerebral hemorrhage, and it is found by Logi st i c regression analysis. These four indexes were closely related to the prognosis of intracerebral hemorrhage. This is in line with the actual clinical phenomenon, that is, with the increase of age, the aggravation of various emergency responses and the lower the risk score, the worse the prognosis of patients with intracerebral hemorrhage. Comparing with the calculation of the volume of intracerebral hemorrhage (ICH), the above indexes can be used to evaluate the degree of illness and prognosis of ICH patients from a more practical point of view. It may provide a more timely and rapid method for the diagnosis of ICH and its prognosis evaluation. Cerebral hemorrhage index (1CHI) is a simple prediction model, which is a supplement to other prediction models.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.34
[Abstract]:Objective Acute intracerebral hemorrhage (AICH) is a common disease that seriously endangers human health. There have been many models for estimating the prognosis of intracerebral hemorrhage in recent studies. The evaluation of prognosis models of cerebral hemorrhage has taken various treatment measures for patients with intracerebral hemorrhage. It is very important to account for the condition of the disease and to utilize the medical resources reasonably. However, the models for predicting the mortality and functional prognosis of (I CH) patients with intracerebral hemorrhage must be combined with high-end equipment, the cost is expensive and the procedure is more complicated. Timeliness is slow. This study established and evaluated a simple, reliable, feasible and reasonable model for predicting the prognosis of intracerebral hemorrhage (ICH) in various hospitals, I. e., intracerebral hemorrhage index (I CHI),). Methods from January 2007 to December 2011, patients with acute cerebral hemorrhage were hospitalized. A total of 780 patients with intracerebral hemorrhage were divided into two groups: intracerebral hemorrhage survival group (590 cases) and intracerebral hemorrhage death group (190 cases). All patients were enrolled to record basic clinical data, including Age,Male.BP,Gu,ALT, high density lipoprotein cholesterol, blood cell analysis, etc. SPSSl5.0 statistical software was used to process the analysis, the qualitative variable rate was expressed, and the baseline characteristics were compared with t test, with P0.05 as the difference. The value of age, blood glucose, white blood cell and GCS score on prognosis of intracerebral hemorrhage was observed. Logi stic regression analysis was performed to evaluate the contribution of various variables to the mortality rate of patients with intracerebral hemorrhage. There was no significant difference between the two groups (P0.05); there were significant differences in blood pressure, alt, HDL cholesterol, blood cell analysis between the two groups (P0.05); and age, blood sugar, White blood cell count (WBC), Glasgow coma score (GCS) was significantly correlated with ICH mortality. The formula of intracerebral hemorrhage index (I CH) was established [I CHI= age (years old) / 10 serum glucose (mmol/L) leukocyte count (109 L) GCS score]. The predictive value of I CHI was evaluated by drawing the (ROC) curve of the operating characteristics of the subjects. The results showed that the area of ROC curve (AURC) was 0.797 (95% CI = 0.762-0.832). The most suitable value of ICH index for mortality was 18. The sensitivity of ICH index to mortality and the specificity of ICH index to mortality were 0.6370.800 and 0.43770.800, respectively. Compared with the total mortality rate (24.39 Ming), the hospital mortality at 18 I CHI27 (mortality rate 45.56%) and I CHI27 (mortality rate 62.86%) increased significantly. Conclusion the number of Age in patients with death in hospital is higher than that in patients with survival. The GCS score of patients with intracerebral hemorrhage is higher than that of patients who die after intracerebral hemorrhage, and it is found by Logi st i c regression analysis. These four indexes were closely related to the prognosis of intracerebral hemorrhage. This is in line with the actual clinical phenomenon, that is, with the increase of age, the aggravation of various emergency responses and the lower the risk score, the worse the prognosis of patients with intracerebral hemorrhage. Comparing with the calculation of the volume of intracerebral hemorrhage (ICH), the above indexes can be used to evaluate the degree of illness and prognosis of ICH patients from a more practical point of view. It may provide a more timely and rapid method for the diagnosis of ICH and its prognosis evaluation. Cerebral hemorrhage index (1CHI) is a simple prediction model, which is a supplement to other prediction models.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R743.34
【参考文献】
相关期刊论文 前10条
1 何素霞;;出血性脑梗死26例临床分析[J];中国实用神经疾病杂志;2010年05期
2 冯涛;娄季宇;白宏英;杨霄鹏;曾志磊;王金兰;;克罗卡林对急性脑缺血再灌注大鼠的脑保护作用[J];中国实用神经疾病杂志;2010年24期
3 赵莲,鲁文江;脑卒中后血液白细胞数目的临床意义[J];脑与神经疾病杂志;1997年03期
4 傅琦;活化白细胞在脑血管疾病发病中的作用机理[J];国外医学(脑血管疾病分册);1994年04期
5 刘静,蔡定芳;中性白细胞与脑缺血再灌注损伤[J];国外医学(脑血管疾病分册）;2001年06期
6 呼铁民;孙t畔，
本文编号：2254594
本文链接：https://www.wllwen.com/yixuelunwen/jjyx/2254594.html
最近更新
教材专著
