影响高血压脑出血手术治疗预后因素的分析

发布时间：2018-04-25 09:27

本文选题：高血压脑出血 + 因素　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的用统计学的方法分析HICH患者的性别、年龄、发病后瞳孔变化（有无脑疝形成）、GCS评分、中线移位和出血部位、出血是否破入脑室、血肿量和术后并发症如术后再出血、上消化道出血、肺部感染等因素对开颅术后高血压脑出血患者预后的影响，并结合实际临床应用探讨对改善HICH患者预后可以采取的措施和方法。方法回顾性分析大连医科大学附属第一医院神经外科一病区2012年6月至2013年12月以来收治的236例HICH病例,从入院时患者性别、年龄、GCS评分、血肿量、瞳孔变化（有无脑疝形成）、中线移位和出血部位、出血是否破入脑室和术后并发症如术后再出血、上消化道出血、肺部感染等因素对本病预后的影响。以患者术后一个月的神经功能恢复情况为标准，选用GOS评分来判断患者预后情况。资料统计方法：单因素分析方法：研究中二分类变量采用四格表资料x2检验,多分类变量资料采用行x列表资料x2检验;统计数据使用SPSS19.0统计软件进行统计学分析。结果以术后一月GOS评分判定236例HICH患者的预后情况。其中3-5分视为预后较好组，，预后较好者共计142例；以1-2分视为预后不良组，预后较差者共计94例。比较不同患者术前GCS评分对开颅手术患者预后有统计学意义（χ2=40.311, P＜0.001）；术前瞳孔是否散大对开颅手术患者预后有统计学意义（χ2=10.796,P＜0.05）；不同的术前血肿量对开颅手术患者预后有统计学意义（χ2=25.384,P＜0.001）；患者术前是否有中线移位及程度对开颅手术患者预后有统计学意义（χ2=15.269, P＜0.001）；HICH血肿破入脑室对开颅手术患者预后有统计学意义（χ2=14.696，P＜0.001）；术后是否再出血对开颅手术患者预后有统计学意义（χ2=22.763，P＜0.001）；是否肺部感染大对开颅手术患者预后有统计学意义（χ2=23.036，P＜0.001）；患者的性别对开颅手术患者预后无统计学意义（χ2=1.145,P＞0.05）；患者的年龄对开颅手术患者预后无统计学意义（χ2=6.503, P＞0.05）；患者术前出血部位对开颅手术患者预后无统计学意义（χ2=4.489, P＞0.05）；患者术后是否发生消化道出血对开颅手术患者预后无统计学意义（χ2=0.136P＞0.05）；结论综合分析多种量化因素,影响开颅术后高血压脑出血患者预后的因素众多,但关键因素为术前GCS评分、瞳孔变化、术后再出血、中线偏移程度、是否破入脑室、肺部感染及颅内血肿量，以上因素可以作为评价开颅术后高血压脑出血患者预后的指针。从而指导选择合理的治疗手段，协助临床医师进行临床决策。
[Abstract]:Objective to analyze the gender, age, pupillary changes after onset of HICH by statistical method (whether there were any cerebral hernia or not, midline displacement and bleeding location, whether the hemorrhage broke into the ventricle, the amount of hematoma and postoperative complications such as postoperative rebleeding). The effect of upper gastrointestinal hemorrhage and pulmonary infection on the prognosis of hypertensive intracerebral hemorrhage after craniotomy was discussed. The measures and methods to improve the prognosis of HICH patients were discussed in combination with the practical clinical application. Methods A retrospective analysis was made on 236 cases of HICH admitted from June 2012 to December 2013 in the Department of Neurosurgery, the first affiliated Hospital of Dalian Medical University. Pupillary changes (formation of cerebral hernia, midline displacement and location of hemorrhage, rupture of ventricle and postoperative complications such as postoperative rebleeding, hemorrhage of upper digestive tract, pulmonary infection, etc.) influence on prognosis of the disease. According to the recovery of neurological function one month after operation, GOS score was used to judge the prognosis of the patients. Data statistic method: single factor analysis method: in the study, two classified variables were tested by four-grid table data x2 test, and multi-classified variable data by x-list data x2 test, and statistical data were analyzed by SPSS19.0 statistical software. Results the prognosis of 236 patients with HICH was evaluated by GOS score one month after operation. Among them, 3-5 scores were regarded as the better prognosis group, 142 cases as the better prognosis group, and 94 cases as the poor prognosis group with 1-2 points as the poor prognosis group. Compared with the preoperative GCS scores of different patients, the prognosis of patients undergoing craniotomy was statistically significant (蠂 2: 40.311, P < 0.001), the preoperative pupil dilatation was statistically significant to the prognosis of patients undergoing craniotomy (蠂 ~ (2)) 10.796 (P < 0.05); the quantity of hematoma before operation had a significant effect on the prognosis of patients undergoing craniotomy (蠂 ~ (2)). Statistical significance was found (蠂 ~ 2 ~ 2 ~ (25.384) P < 0.001), whether there was midline shift or not before operation was statistically significant for prognosis of patients undergoing craniotomy (蠂 ~ (2) = 15.269, P < 0.001). The prognosis of patients undergoing craniotomy was statistically significant (蠂 ~ 2 ~ 2 ~ (14.696) P < (0.001)); whether there was another hemorrhage after craniotomy was statistically significant (蠂 ~ (2) = 15.269, P < (0.001)). The prognosis of patients undergoing craniotomy was statistically significant (蠂 ~ 2 + 22.763 P < 0.001); the prognosis of patients undergoing craniotomy was significantly higher than that of patients with pulmonary infection (蠂 ~ (2) = 23.036 (P < 0.001); the sex of patients had no significant difference in the prognosis of patients undergoing craniotomy (蠂 ~ (2)) 1.145 (P > 0.05); the age of the patients had no significant difference in the prognosis of patients undergoing craniotomy (蠂 ~ (2)). There was no significant difference in the prognosis of the patients with craniotomy (蠂 ~ 2 = 6.503, P > 0.05), there was no significant difference in the prognosis of the patients undergoing craniotomy (蠂 ~ 24.489, P > 0.05), and there was no significant difference in the prognosis of the patients with postoperative gastrointestinal bleeding (蠂 ~ (2) 0.136 P > 0.05). Conclusion there are many factors that influence the prognosis of hypertensive intracerebral hemorrhage after craniotomy, but the key factors are preoperative GCS score, pupil change, postoperative rebleeding, midline deviation, and whether or not to break into the ventricle. The above factors can be used to evaluate the prognosis of hypertensive intracerebral hemorrhage after craniotomy. To guide the selection of reasonable treatment methods, to assist clinicians in clinical decision-making.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34

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