高血压脑出血手术治疗的预后影响因素分析
发布时间：2019-06-02 15:45
【摘要】：目的:了解高血压脑出血(Hypertensiveintracerebral hemorrhage,HICH)的一般临床特点,运用统计学方法对HICH患者的年龄、性别、入院收缩压(SBP)、入院血糖、术后肺部感染情况、术前瞳孔大小、GCS昏迷评分、出血部位、中线移位、脑出血量、手术时机、出血破入脑室、是否发生二次出血等因素对手术后高血压脑出血患者预后的影响。对能改善HICH患者预后的相关因素,可给予临床干预。采用科学而合理的决策以期改善HICH患者预后。方法:选择收集皖南医学院第一附属医院神经外科2015.01—2016.10期间收住入院的118例HICH患者,并对其术前影像学资料、相关临床数据、术后资料等行回顾分析,包括患者的年龄、入院收缩压(SBP)、术后是否发生肺部感染、瞳孔大小、血糖高低、GCS昏迷评分、出血部位、中线移位情况、脑出血量、手术时机、是否发生二次出血等十三项因素。根据格拉斯哥预后评分(GOS)来判断患者术后1月的恢复情况,可以量化评判患者术后的情况。统计资料的分析方法:采用单因素分析方法:对所选数据运用SPSS16.0软件,根据卡方检验(χ~2检验)进行分析。结果:根据GOS评分来判断118例高血压脑出血病人术后1个月后的恢复情况。评分在3-5范围的病人归为预后良好,预后良好有71人;评分在1-2分范围的病人归为预后不良,预后不良47人。其中:1.高血压脑出血病人入院GCS昏迷评分对术后恢复情况的影响(χ~2=18.514,P=0.000);2.术前血糖值的高低对HICH病人的预后影响(χ~2=7.212,P=0.007);3.颅内出血量对术后HICH病人的预后影响(χ~2=10.909,P=0.004);4.术前瞳孔的改变对手术后病人的预后影响(χ~2=10.872,P=0.001);5.术前收缩压的高低对HICH患者预后的影响(χ~2=8.397,P=0.004);6.中线是否发生移位对经外科治疗患者的预后影响(χ~2=4.604,P=0.032);7.发生HICH后血肿破入脑室对术后患者的预后影响(χ~2=6.363,P=0.012);8.HCIH病人术后是否发生二次出血对患者的预后影响(χ~2=6.894,P=0.009);9.HICH患者术后发生肺部感染对其预后影响(χ~2=10.273,P=0.001);10.不同手术时机的选择对开颅术后患者的预后影响(χ~2=5.158,P=0.076);11.性别对开颅术后患者的预后影响(χ~2=0.014,P=0.905);12.年龄对开颅手术后HCIH病人预后影响(χ~2=4.303,P=0.116);13.根据影像资料HICH病人术前出血部位对术后预后影响(χ~2=6.575,P=0.037)。结论:HICH患者经过开颅手术后,影响其预后的因素多样且复杂,通过对临床资料和数据分析,可以得出较为合理的结论。在所统计的各种因素中:HICH病人入院收缩压(SBP)的高低、术后是否发生肺部感染、瞳孔大小、GCS昏迷评分、血肿位置、中线有无移位、脑出血量、术后是否二次出血、出血是否破入脑室、血糖高低等因素有统计学意义。而HICH病人年龄、性别以及手术时机的选择,经分析可知并非影响预后的决定性因素。为此,在临床中若能对能提高HICH患者预后的相关因素,给予适当的处理有可能使HICH病人受益。科学而合理的决策对改善HICH患者预后,降低其死亡率和致残率,提高生存率和生活质量将有很大的帮助。
[Abstract]:Objective: To study the general clinical characteristics of hypertensive cerebral hemorrhage (HICH). The age, sex, systolic blood pressure (SBP), admission blood sugar, postoperative pulmonary infection, pre-operative pupil size, GCS coma score, bleeding position and midline shift of HICH were studied by statistical method. The effect of post-operative hypertensive cerebral hemorrhage on the prognosis of patients with hypertensive cerebral hemorrhage after operation, such as the amount of cerebral hemorrhage, the timing of operation, the bleeding of the hemorrhage into the ventricle, and the occurrence of secondary hemorrhage. Clinical intervention can be given to factors that can improve the prognosis of HICH patients. Scientific and reasonable decision-making is used to improve the prognosis of HICH patients. Methods:118 HICH patients admitted to the hospital during the neurosurgery of the first Affiliated Hospital of Anhui Medical College during the period of 2015.01-2016.10 were selected, and the preoperative imaging data, relevant clinical data and postoperative data were retrospectively analyzed, including the age of the patient, systolic blood pressure (SBP), Thirteen factors such as pulmonary infection, pupil size, blood glucose level, GCS coma score, hemorrhage site, midline shift, cerebral hemorrhage, operation timing, and whether secondary hemorrhage occurred after operation. According to the Glasgow Outcome Score (GOS), the patient's recovery in January was determined, and the post-operative condition of the patient could be quantified. Analysis method of statistical data: using the single factor analysis method: using the SPSS16.0 software for the selected data, and analyzing according to the chi-square test (1-2 test). Results: The recovery of 118 patients with hypertensive cerebral hemorrhage after 1 month after operation was determined according to the GOS score. Patients with a score of 3-5 were classified as good prognosis and good prognosis; patients with a score of 1-2 were classified as poor prognosis and poor prognosis. In which:1. The effect of GCS (2 = 18.514, P = 0.000) on the post-operative recovery of patients with hypertensive cerebral hemorrhage was affected (P = 18.514, P = 0.000). The effect of preoperative blood glucose level on the prognosis of HICH patients (1 ~ 2 = 7.212, P = 0.007); The effect of intracranial hemorrhage on the prognosis of HICH patients after operation (1 ~ 2 = 10.909, P = 0.004); The effect of pre-operative pupillary change on the prognosis of patients after operation (1-2 = 10.872, P = 0.001);5. The effect of preoperative systolic blood pressure on the prognosis of HICH patients (1 ~ 2 = 8.397, P = 0.004); Whether the median line is displaced is affected by the outcome of the surgical treatment (1-2 = 4.604, P = 0.032);7. The prognosis of patients with HICH after HICH was affected (1 ~ 2 = 6.363, P = 0.012).8. The effect of secondary hemorrhage on the prognosis of HCIH patients after operation (1 ~ 2 = 6.894, P = 0.009);9. The effect of postoperative pulmonary infection on the prognosis of HICH (1 ~ 2 = 10.273, P = 0.001);10. The choice of time of operation on the prognosis of the patients after craniotomy (1-2 = 5.158, P = 0.076);11. The effect of gender on the prognosis of patients after craniotomy (1-2 = 0.014, P = 0.905); The effect of age on the prognosis of HCIH patients after craniotomy (1-2 = 4.303, P = 0.116);13. The effect of pre-operative bleeding on the prognosis of the patients with HICH according to the image data was (1-2 = 6.575, P = 0.037). Conclusion: After the operation of the craniotomy, the factors that affect the prognosis of the HICH are diverse and complex, and a reasonable conclusion can be drawn through the analysis of clinical data and data. Among the various factors, HICH was admitted to the high and low systolic blood pressure (SBP) of the patient, whether the pulmonary infection, the size of the pupil, the GCS coma score, the position of the hematoma, the presence or absence of the midline, the amount of the cerebral hemorrhage, the second bleeding after the operation, whether the bleeding is broken into the ventricle, The blood sugar level and other factors are of statistical significance. The age, sex, and timing of the operation of HICH are not the decisive factors that affect the prognosis. To this end, it is possible to benefit the HICH patients by giving appropriate treatment to the clinically relevant factors that can improve the prognosis of the HICH patients. Scientific and reasonable decision-making can help improve the prognosis of HICH patients, reduce the mortality and disability rate, and improve the survival rate and quality of life.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12
本文编号：2491229
[Abstract]:Objective: To study the general clinical characteristics of hypertensive cerebral hemorrhage (HICH). The age, sex, systolic blood pressure (SBP), admission blood sugar, postoperative pulmonary infection, pre-operative pupil size, GCS coma score, bleeding position and midline shift of HICH were studied by statistical method. The effect of post-operative hypertensive cerebral hemorrhage on the prognosis of patients with hypertensive cerebral hemorrhage after operation, such as the amount of cerebral hemorrhage, the timing of operation, the bleeding of the hemorrhage into the ventricle, and the occurrence of secondary hemorrhage. Clinical intervention can be given to factors that can improve the prognosis of HICH patients. Scientific and reasonable decision-making is used to improve the prognosis of HICH patients. Methods:118 HICH patients admitted to the hospital during the neurosurgery of the first Affiliated Hospital of Anhui Medical College during the period of 2015.01-2016.10 were selected, and the preoperative imaging data, relevant clinical data and postoperative data were retrospectively analyzed, including the age of the patient, systolic blood pressure (SBP), Thirteen factors such as pulmonary infection, pupil size, blood glucose level, GCS coma score, hemorrhage site, midline shift, cerebral hemorrhage, operation timing, and whether secondary hemorrhage occurred after operation. According to the Glasgow Outcome Score (GOS), the patient's recovery in January was determined, and the post-operative condition of the patient could be quantified. Analysis method of statistical data: using the single factor analysis method: using the SPSS16.0 software for the selected data, and analyzing according to the chi-square test (1-2 test). Results: The recovery of 118 patients with hypertensive cerebral hemorrhage after 1 month after operation was determined according to the GOS score. Patients with a score of 3-5 were classified as good prognosis and good prognosis; patients with a score of 1-2 were classified as poor prognosis and poor prognosis. In which:1. The effect of GCS (2 = 18.514, P = 0.000) on the post-operative recovery of patients with hypertensive cerebral hemorrhage was affected (P = 18.514, P = 0.000). The effect of preoperative blood glucose level on the prognosis of HICH patients (1 ~ 2 = 7.212, P = 0.007); The effect of intracranial hemorrhage on the prognosis of HICH patients after operation (1 ~ 2 = 10.909, P = 0.004); The effect of pre-operative pupillary change on the prognosis of patients after operation (1-2 = 10.872, P = 0.001);5. The effect of preoperative systolic blood pressure on the prognosis of HICH patients (1 ~ 2 = 8.397, P = 0.004); Whether the median line is displaced is affected by the outcome of the surgical treatment (1-2 = 4.604, P = 0.032);7. The prognosis of patients with HICH after HICH was affected (1 ~ 2 = 6.363, P = 0.012).8. The effect of secondary hemorrhage on the prognosis of HCIH patients after operation (1 ~ 2 = 6.894, P = 0.009);9. The effect of postoperative pulmonary infection on the prognosis of HICH (1 ~ 2 = 10.273, P = 0.001);10. The choice of time of operation on the prognosis of the patients after craniotomy (1-2 = 5.158, P = 0.076);11. The effect of gender on the prognosis of patients after craniotomy (1-2 = 0.014, P = 0.905); The effect of age on the prognosis of HCIH patients after craniotomy (1-2 = 4.303, P = 0.116);13. The effect of pre-operative bleeding on the prognosis of the patients with HICH according to the image data was (1-2 = 6.575, P = 0.037). Conclusion: After the operation of the craniotomy, the factors that affect the prognosis of the HICH are diverse and complex, and a reasonable conclusion can be drawn through the analysis of clinical data and data. Among the various factors, HICH was admitted to the high and low systolic blood pressure (SBP) of the patient, whether the pulmonary infection, the size of the pupil, the GCS coma score, the position of the hematoma, the presence or absence of the midline, the amount of the cerebral hemorrhage, the second bleeding after the operation, whether the bleeding is broken into the ventricle, The blood sugar level and other factors are of statistical significance. The age, sex, and timing of the operation of HICH are not the decisive factors that affect the prognosis. To this end, it is possible to benefit the HICH patients by giving appropriate treatment to the clinically relevant factors that can improve the prognosis of the HICH patients. Scientific and reasonable decision-making can help improve the prognosis of HICH patients, reduce the mortality and disability rate, and improve the survival rate and quality of life.
【学位授予单位】：皖南医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651.12
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