个体化治疗基底节区高血压脑出血早期预后的临床研究

发布时间：2018-03-13 18:25

  本文选题：基底节区　切入点：高血压脑出血　出处：《石河子大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:为了探讨高血压基底节区出血治疗的临床疗效,综合详细分析影响其短期预后的相关因素,以达到提高患者的治愈率、降低致残率。方法:此次临床研究在通过结合国内外相关文献资料的研究结果以及丰富的临床治疗经验,进行回顾分析新疆维吾尔自治区人民医院神经外科于2013年5月-2016年12月收治的176例符合纳入及排除标准的脑出血患者。通过筛选决定采用以下变量的临床资料为影响预后的因素:个人资料(年龄、性别),既往史(包括高血压病史),术前一般情况(包括术前收缩压、术前血糖值、术前GCS评分),术前CT表现(包括血肿体积、血肿形态、脑室积血、中线是否移位),手术时间,手术方式,术后发生的并发症(包括术后再出血、肺部感染、上消化道出血);选用日常生活能力(ADL)评分作为判断患者1个月后神经功能恢复情况的标准,按临床预后情况分为两组:1、预后良好组,其ADL评分为I、II、III级;2、预后不良组,其ADL评分为IV、V级。采用c2检验进行单因素分析;然后将对预后有统计学意义的单因素引入多元逻辑回归模型,综合分析这些影响因素与预后的相关性。结果:(1)收集176例符合研究要求的患者进行临床研究。包括男性117例,女性59例,年龄范围在30~80岁之间,平均(54.47±9.23)岁,既往高血压病史范围在1~31年之间,平均(6.95±5.76)年,术前收缩压值范围在128~224mmHg之间,平均(147.76±27.51)mmHg,术前血糖值范围在4.2~22.2mmol/L之间,平均(8.02±3.53)mmol/L,术前GCS评分范围在6~14分之间,平均(10.65±2.32)分,左侧基底节区95例,右侧基底节区81例,血肿体积范围在24~65ml之间,平均(38.42±10.22)ml,血肿形态不规则77例,血肿破入脑室积血41例,中线移位45例,入院至手术时间范围在8~72h之间,平均(21.46±8.35)h,行微创血肿穿刺引流术95例,行开颅血肿清除术81例,术后发生二次出血16例,术后发生肺部感染63例,术后发生上消化道出血9例,预后良好86例,预后不良90例。(2)单因素采用c2检验分析结果:患者年龄、术前血糖值、术前GCS评分、血肿体积、血肿形态、入院至手术时间、血肿破入脑室积血、中线发生移位、术后再出血、术后肺部感染10个因素对患者的预后有明显影响。(3)以P=0.05为检验标准,将有统计学意义的单因素纳入多元逻辑回归模型中,综合分析得到结果显示:患者年龄、术前血糖值、术前GCS评分、血肿体积、入院至手术时间与预后具有负相关性;血肿是否规则、血肿破入脑室是否积血、术后是否再出血、术后肺部是否感染与患者预后具有正相关性。结论:经过统计学综合分析高血压基底节区出血患者的早期预后影响因素,可以得到以下结论:1、通过单因素采用c2检验分析说明患者年龄、术前血糖值、术前GCS评分、血肿体积、血肿形态、入院至手术时间、血肿破入脑室积血、中线发生移位、术后再出血、术后肺部感染10个因素对患者的预后有明显影响。2、通过多元逻辑回归模型分析说明患者年龄、术前血糖值、术前GCS评分、血肿体积、血肿破入脑室积血、术后再出血、术后肺部感染是独立关键影响因素。明确以上相关因素,在临床上给予重视并加以干涉和治疗,对患者神经功能恢复产生积极的效果,达到改善患者预后的目的,对提高患者的治愈率、降低致残率方面具有临床指导意义。
[Abstract]:Objective: To investigate the clinical effect in the treatment of hypertensive basal ganglia hemorrhage, with comprehensive analysis of relevant factors influencing the short-term prognosis, in order to improve the cure rate of patients, reduce the disability rate. Methods: the clinical study in the combination of domestic and foreign literature research results and rich clinical experience, were retrospectively analyzed in Department of Neurosurgery the Xinjiang Uygur Autonomous Region people's Hospital in May 2013 -2016 year in December 176 cases met the inclusion and exclusion criteria of patients with cerebral hemorrhage. The clinical data by screening decision using the following variables as prognostic factors: personal information (age, gender), medical history (including hypertension), preoperative general condition (including preoperative systolic blood pressure. Preoperative blood glucose, preoperative GCS score), preoperative CT findings (including the volume of hematoma, hematoma, intraventricular hemorrhage, midline shift, the operation time is), Surgical methods, postoperative complications (including postoperative hemorrhage, pulmonary infection, upper gastrointestinal bleeding); the ability of daily life (ADL) score was used as the recovery of the neurological function of patients after 1 months of standard, according to the clinical prognosis were divided into two groups: 1 patients with good prognosis, the ADL score I, II, III; 2, the poor prognosis group, the ADL score is IV, V. C2 test was used for univariate analysis; single factor and statistical significance on the prognosis of the multivariate logistic regression model was introduced, a comprehensive analysis of these factors and the correlation between the prognosis. Results: (1) 176 patients met the study requirements of patients with clinical research. Including male 117 cases, female 59 cases, age between 30~80 years old, the average (54.47 + 9.23) years old, had a history of hypertension in the range of 1~31 years, the average (6.95 + 5.76) years, preoperative systolic blood pressure values in the range of 128~224mmHg, the average (14 7.76卤27.51)mmHg,鏈�鍓嶈。�

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