MIS评分：自发性脑出血微钻孔引流术预测模型

发布时间：2018-08-03 19:58

【摘要】：背景和目的:在中国,每年大约有一千多万人罹患中风;其中约一百五十万人死于中风,约有六百万至七百万人生存下来。在中国,首次脑内出血(ICH)的发生率为每年每10万人中有27.1-77.1例。在所有脑卒中患者中,出血性脑卒中的比例为17.1%至55.4%,远远高于在西方人群中的发病率(6.5-19.6%)。出血性脑卒中的发病率和死亡率都明显高于脑梗死及蛛网膜下腔出血(SAH)的发病率和死亡率。近年来,创新性微创手术越来越多地应用于治疗中国的自发性出血性脑卒中患者,因其要求较少的技能,简单易操作,并且已被证明是非常安全、有效。但是,手术治疗的作用仍然存在较大的争议。许多自发性出血性脑出血的患者近年来确实从微创手术中受益。一个由中国国家脑血管疾病预防和控制中心设计的多中心、随机对照临床试验显示,微创手术在改善神经功能比保守治疗较大优越性,并在总的来说是一种安全、实用的治疗方法。然而,对于手术指证的把握仍存在较大争议。本研究的目的是分析影响微钻孔引流术患者30天预后危险因素,并且提出一个简单实用的评分(MIS评分)指导临床手术更加有效地实施。研究方法:回顾性分析2015年10月-2016年10由山东大学附属千佛山医院行自发性脑出血微钻孔引流加尿激酶冲洗术患者101例。根据改良Rankin scale评分表,评估患者30天预后情况,并且将其分为预后好(评分在0-3)与预后差(评分在4-6)。所有可能影响预后危险因素被记录。应用logistic回归分析和单因素分析确定影响患者30天预后危险因素。本研究所有数据处理使用SPSS(Version 20.0)进行数据处理;当P0.05时表明结果有统计学意义。最后根据分析结果,制定临床评分量表(MIS评分)。研究结果:单因素结果分析,影响微钻孔引流术患者30天预后危险因素有格拉斯哥评分(P0.01)、年龄大于80岁(P0.05)、血糖(P0.01),脑血肿大小(P0.01),手术时间(P0.05)及脑室出血(P0.001)。Logistic回归分析结果表明影响脑出血30天预后危险因素有格拉斯哥评分(P0.05)、年龄(P0.05)、血肿大小(P0.01)及脑室出血(P0.05)。根据结果制定MIS评分表。MIS评分在0-1分患者中有39人预后好,然而MIS评分在2-5分只有9人预后好。研究结论:MIS评分表是一个简单、实用的评分量表,可以利用该量表选择适合微创引流手术患者。当MIS评分在0-1的自发性脑出血患者强烈推荐行微钻孔引流加尿激酶冲洗术。然而对于评分表有效性需要进一步前瞻性研究。
[Abstract]:Background and objective: in China, about 10 million people suffer from stroke each year; about 1.5 million die of stroke and 6 million to 7 million survive. In China, the incidence of first-time intracerebral hemorrhage (ICH) is 27.1-77.1 per 100000 population per year. The proportion of hemorrhagic stroke in all stroke patients ranged from 17.1% to 55.4%, which was much higher than that in the western population (6.5-19.6%). The morbidity and mortality of hemorrhagic stroke were significantly higher than that of cerebral infarction and subarachnoid hemorrhage (SAH). In recent years, innovative minimally invasive surgery has been used more and more in the treatment of spontaneous hemorrhagic stroke patients in China. It requires less skills, is simple and easy to operate, and has been proved to be very safe and effective. However, the role of surgical treatment is still controversial. Many patients with spontaneous hemorrhagic intracerebral hemorrhage do benefit from minimally invasive surgery in recent years. A randomized controlled clinical trial designed by China's National Center for the Prevention and Control of Cerebrovascular Diseases shows that minimally invasive surgery is superior to conservative treatment in improving neurological function and is generally safe. A practical treatment. However, the assurance of surgical evidence is still controversial. The purpose of this study was to analyze the prognostic risk factors of patients undergoing microdrilling drainage in 30 days, and to propose a simple and practical score (MIS score) to guide the clinical operation more effectively. Methods: 101 cases of spontaneous intracerebral hemorrhage were treated with microdrilling drainage and urokinase washing from October 2015 to October 2016 by Qianfushan Hospital affiliated to Shandong University. According to the modified Rankin scale, the prognosis of 30 days was evaluated and divided into good prognosis (0-3) and poor prognosis (4-6). All possible prognostic risk factors were documented. Logistic regression analysis and univariate analysis were used to determine the prognostic risk factors. Data processing in this study using SPSS (Version 20.0) data processing; when P0.05 showed that the results were statistically significant. Finally, according to the analysis results, the clinical score scale (MIS score) was established. Results: single factor analysis, Glasgow score (P0.01), age more than 80 years (P0.05), blood glucose (P0.01), size of cerebral hematoma (P0.01), operative time (P0.05) and intraventricular hemorrhage (P0.001) .Logistic regression analysis showed that the prognosis of 30 days of cerebral hemorrhage was affected by the factors influencing the prognosis of microborehole drainage patients (P0.01). The risk factors were Glasgow score (P0.05), age (P0.05), hematoma size (P0.01) and ventricular hemorrhage (P0.05). According to the results, 39 patients with 0-1 score had a good prognosis, while only 9 patients with MIS score 2-5 had a good prognosis. Conclusion the score list of the 10% MIS is a simple and practical scale, which can be used to select the patients with minimally invasive drainage surgery. Patients with spontaneous intracerebral hemorrhage with MIS score 0-1 are strongly recommended for microborehole drainage and urokinase washing. However, further prospective research is needed on the validity of the scale.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.1

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