脑室出血外科治疗预后的相关因素研究

发布时间：2018-06-27 08:17

本文选题：脑室出血 + 脑室外引流　；参考：《吉林大学》2014年硕士论文

【摘要】：背景和目的：脑室出血(Intraventricular hemorrhage,IVH)是一种神经外科临床中极为常见的危急症，研究资料表明其具有较高的发病率，且预后多不良。近些年相关的临床研究表明，在脑室出血的早期快速清除脑室内的积血并将其引流到体外，逐渐将血性脑脊液更新至正常水平，疏通脑脊液循环通道，保证脑积液的正常循环，不仅能够迅速解除血凝块因占位效应对周围脑组织的压迫性损伤，而且还能减少积血的各种代谢产物所介导的脑组织水肿及化学性损伤。其中以脑室外引流(external ventricular drainage,EVD)术为核心的外科治疗手段的有效性已经被广泛认可，但国内EVD开展的时间并不长，且各个治疗中心预后不一，有关脑室出血预后的影响因素及影响力大小缺乏系统、全面的研究。本课题通过对脑室出血外科治疗后的病例进行回顾性研究，以探讨影响脑室出血外科治疗预后的相关因素，以及各个影响因素影响力的大小，以便为临床提供更好的治疗方法和预后判断，为以后的临床治疗决策提供相关的科学依据。资料和方法：本次研究将2011年10月至2013年11月期间，于吉林大学中日联医院神经外一科住院治疗的所有脑室出血患者（共387例）的病历资料，按照病例纳入标准及排除标准最终将153例脑室出血病例纳入本次课题研究。将患者入院时的一般情况、发病症状、一般查体及神经系统检查、影像学检查资料、外科治疗方式、所继发的并发症等确定为自变量（其中部分变量进行数值化处理），以患者治疗三个月后斯堪的纳维亚脑卒中量表（ScandinavianStrokeScale,SSS）评分作为因变量。先采用单因素分析筛选出对预后有影响的相关单个因素，再以单因素分析所得出的与脑室出血（IVH）外科治疗预后有统计学意义的因素为自变量，，以3个月后患者SSS评分为因变量，进行多元线性逻辑回归分析，得出各因素对脑室出血外科治疗预后影响的大小。结果：通过单因素分析筛选，其中有9个因素对脑室出血外科治疗预后有明显的影响（P＜0.05）。后通过多元线性逻辑回归模型结果显示：年龄、入院时血糖值、脑室内积血量、入院时收缩压与预后具有负相关性，即年龄越大、入院时血糖越高、脑室内积血量越多、入院时收缩压越高，预后越差；入院时GCS评分(Glasgow Coma Scale,GCS评分)、是否第三及第四脑室积血、是否发生急性脑积水、是否发生应激性溃疡、是否发生肺部感染与预后具有正相关性，即术前GCS评分越低、第三及第四脑室内积血越多、越早发生急性脑积水、应激性溃疡越严重，肺部感染越严重，预后越差。结论： 1.单因素分析表明19项纳入本研究的影响因素中有9项对脑室出血外科治疗预后有影响，包括：年龄、入院时GCS评分、侧脑室及第三四脑室积血、侧脑室积血、入院时血糖值、急性脑积水、入院时收缩压、应激性溃疡、肺部感染。 2.根据多元线性逻辑回归方程显示，各个因素对脑室出血外科治疗预后影响力的大小从高到低依次是：侧脑室及第三四脑室积血、侧脑室积血量、肺部感染、急性脑积水、入院时GCS评分、应激性溃疡、入院时收缩压、年龄、入院时血糖值。而且，各影响因素有累加效应。
[Abstract]:Background and purpose:
Intraventricular hemorrhage (IVH) is a very common crisis in Department of neurosurgery. Research data show that it has high incidence and poor prognosis. The spinal fluid is updated to the normal level and dredges the circulation channel of cerebrospinal fluid to ensure the normal circulation of the hydrocephalus. It can not only quickly relieve the compression damage of the blood clot due to the occupying effect on the surrounding brain tissue, but also reduce the brain tissue edema and chemical damage mediated by the various metabolites of the hematoma. Among them, the external drainage of the brain (external VE) is used. The effectiveness of ntricular drainage, EVD) as the core of surgical treatment has been widely recognized, but the time of the domestic EVD is not long, and the prognosis of each treatment center is not one. The factors affecting the prognosis of the ventricle hemorrhage and the size of the influence are lack of a systematic and comprehensive study. A retrospective study was conducted to explore the related factors affecting the prognosis of surgical treatment of ventricular hemorrhage, as well as the influence of various factors, so as to provide better therapeutic methods and prognostic judgments for clinical treatment, and to provide a scientific basis for future clinical treatment decisions.
Information and methods:
In this study, from October 2011 to November 2013, the medical records of all the patients with cerebral hemorrhage (387 cases) hospitalized at the Department of Neurology in the Jilin University, China and Japan Union Hospital (a total of 153 cases of cerebral hemorrhage were included in this study. The general situation of admission to the hospital, the onset of the disease, was taken into account. " Symptoms, general examination and nervous system examination, imaging examination data, surgical treatment, and secondary complications were determined as independent variables (part of the variables were numerically treated), and the Scandinavia Stroke Scale (ScandinavianStrokeScale, SSS) score was used as the dependent variable after three months of treatment. The factors related to prognosis were screened out, and the factors of statistical significance in the surgical treatment of ventricular hemorrhage (IVH) were statistically significant in the single factor analysis. The multivariate linear logistic regression analysis was carried out with the SSS score of 3 months later, and the effects of various factors on the prognosis of surgical treatment of ventricular hemorrhage were obtained. Size.
Result:
Through single factor analysis, 9 factors had significant influence on the prognosis of surgical treatment of ventricular hemorrhage (P < 0.05). The results of multiple linear logistic regression showed that age, blood sugar, intraventricular volume of blood, systolic blood pressure at admission and prognosis were negatively correlated, that is, the older the age, the higher the blood glucose at admission, the ventricles of the brain. The more the volume of inner product, the higher the systolic blood pressure, the worse the prognosis, the GCS score (Glasgow Coma Scale, GCS score) at admission, whether third and the four ventricle accumulated blood, whether there is acute hydrocephalus, whether there is a stress ulcer, whether there is a positive correlation between the pulmonary infection and the prognosis, that is, the lower the preoperative GCS score, third and the four brain chamber. The more blood is accumulated, the earlier the incidence of acute hydrocephalus is, the more serious the stress ulcer is, the more serious the lung infection is, the worse the prognosis.
Conclusion:
1. single factor analysis showed that 9 of the 19 factors involved in the study had an impact on the prognosis of surgical treatment of ventricular hemorrhage, including age, GCS score at admission, lateral ventricle and three or four ventricle accumulation, lateral ventricle accumulation, blood glucose value at admission, acute hydrocephalus, systolic pressure at admission, stress ulcers, and pulmonary infection.
2. according to the multiple linear logistic regression equation, the influence of various factors on the prognosis of surgical treatment of ventricular hemorrhage from high to low were: lateral ventricle and three or four ventricle accumulation, lateral ventricle accumulation, pulmonary infection, acute hydrocephalus, GCS score, stress ulcer, systolic pressure at admission, age, and blood glucose at admission. Moreover, the influence factors have cumulative effect.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34

【参考文献】