幕上高血压脑出血预后影响因素的研究
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摘要
目的探讨影响幕上高血压脑出血患者预后的相关因素,为指导临床治疗和预后评估提供依据。
方法回顾分析我院神经外科2001年1月至2006年1月五年间共收治的324例符合本研究纳入标准的幕上高血压脑出血病例。以收集的一般资料、既往史、现病史、入院查体、影像学资料、实验室检查、治疗方式、并发症等资料为自变量,发病后1个月功能独立性评定(Functional independence measure,FIM)评分为因变量,通过成组计量资料进行t检验及方差分析,连续计量资料进行线性相关分析筛选出对预后有影响的因素;并建立多重线性回归模型,进一步筛选分析对预后有影响的因素,以及各因素的影响力。
结果
1、以发病后1个月FIM评分为因变量,收集的一般资料、既往史、现病史、入院查体、影像学资料、实验室检查、治疗方式、并发症等资料为自变量,对预后影响有统计学意义的自变量有:呼吸系统疾病史、发病时间、是否有呕吐、是否有肢体活动障碍、是否有意识障碍、是否有语言障碍、是否有二便失禁、入院时收缩压、入院时舒张压、入院时平均动脉压、入院GCS评分、瞳孔直径、瞳孔对光反射分级、肢体肌力分级、是否出现病理征、是否出现颈阻、血肿左右、血肿部位、是否出现脑疝、血肿体积、血肿体积扩大、血肿体积增大的量、是否有脑室积血、脑室积血量、是否脑室内铸型、是否出现急性脑积水、是否有中线移位、入院血糖、入院白细胞计数、完全内科治疗、是否行气管切开、是否出现肺部感染、是否出现应激性溃疡、是否出现消化道感染。
2、以发病后1个月FIM评分为因变量,进行单因素分析筛选出有统计学意义的各个因素为自变量,建立多重线性回归模型,采用逐步向前法,所得到的标准化多重线性回归方程为Y? =-0.085X1+0.216X2-0.235X3-0.368X4-0.093X5-0.113X6-0.173X7 ,P<0.05,有统计学意义。其中Y?为因变量即发病后1个月FIM评分,X1-7为自变量,依次代表入院时收缩压、入院GCS评分、是否有脑室积血、血肿体积、是否出现应激性溃疡、血肿体积扩大、是否出现肺部感染;X的系数为标准化偏回归系数。标准化偏回归系数绝对值的大小代表了其对SICH预后影响的大小。
结论血肿体积、入院GCS评分、脑室是否积血、是否肺部感染、血肿体积扩大、是否发生应激性溃疡、入院时收缩期血压是幕上高血压脑出血预后的关键性预测指标,在临床中应该重视和加强对这些因素的治疗、控制和预防。
Objective To discuss the influencing factors of supratentorial hypertensive intracerebral hemorrhage, and to compare their influence to the prognosis of SICH.
Methods Retrospective analyzed the 324 consecutive cases with SICH admitted in Department of Neurosurgery, Second Affiliated Hospital, Chong Qing University of Medical Science, from January 2001 to January 2006, with general data, symptoms onset, signs on admission, imageological data, therapy strategies and complications as independent variables, and FIM after 1 month as dependent variable. Grouped measurement data used t-test and F-test, continuous mea- surement data used linear correlation analysis, screened the influencing factors of prognosis of SICH, then the valuable influencing factors were filtrated and formulated with multiple regression analysis model and their contribution were compared.
Results
1. The factors with significant influence to the prognosis were screened out with t-test、F-test and linear correlation analysis. These factors include disease history of respiratory system, onset time, vomit, disorder of limbs activity, conscious disturbance, urinary and fecal incontinence, systolic pressure on admission, diastolic pressure on admission, mean arterial pressure on admission, GCS on admission, pupillary diameter, grade of pupillary light reflex, grade of limbs muscle force, pathological reflexes, neck rigidity, side of haematoma, location of haematoma, brain hernia, volume of haematoma, haematoma enlargement, augmented volume after haematoma enlargement, ventricular blood whether or not and its volume, ventricular casting mould, acute hydrocephalus, midline shift on CT scan, blood glucose on admission, leucocyte count on admission, completely medical treatment, incision of trachea, pulmonary infection, stress ulcer, alimentary infection.
2. Multiple regression analysis by forward stepwise were performed. The equation is as follows Y? =-0.085X1+0.216X2-0.235X3- 0.368X4- 0.093X5-0.113X6-0.173X7 , P<0.05, Y? is dependent variable, X1-7 are independent variables which represent systolic pressure on admission, GCS on admission, ventricular blood whether or not, volume of haematoma, stress ulcer, haematoma enlargement, pulmonary infection; the coefficient of X is standardized partial regression coefficient. The absolute value of the standardized partial regression coefficient in the equation denote the difference of such factors’influence to the prognosis of SICH.
Conclusion It is suggested that volume of haematoma, GCS on admission, ventricular blood whether or not, pulmonary infection ,haematoma enlargement, stress ulcer, systolic pressure on admission are the critical predicted index of prognosis of SICH, and we should pay attention and strengthen the treatment, control and prevention to them in clinic.
方法回顾分析我院神经外科2001年1月至2006年1月五年间共收治的324例符合本研究纳入标准的幕上高血压脑出血病例。以收集的一般资料、既往史、现病史、入院查体、影像学资料、实验室检查、治疗方式、并发症等资料为自变量,发病后1个月功能独立性评定(Functional independence measure,FIM)评分为因变量,通过成组计量资料进行t检验及方差分析,连续计量资料进行线性相关分析筛选出对预后有影响的因素;并建立多重线性回归模型,进一步筛选分析对预后有影响的因素,以及各因素的影响力。
结果
1、以发病后1个月FIM评分为因变量,收集的一般资料、既往史、现病史、入院查体、影像学资料、实验室检查、治疗方式、并发症等资料为自变量,对预后影响有统计学意义的自变量有:呼吸系统疾病史、发病时间、是否有呕吐、是否有肢体活动障碍、是否有意识障碍、是否有语言障碍、是否有二便失禁、入院时收缩压、入院时舒张压、入院时平均动脉压、入院GCS评分、瞳孔直径、瞳孔对光反射分级、肢体肌力分级、是否出现病理征、是否出现颈阻、血肿左右、血肿部位、是否出现脑疝、血肿体积、血肿体积扩大、血肿体积增大的量、是否有脑室积血、脑室积血量、是否脑室内铸型、是否出现急性脑积水、是否有中线移位、入院血糖、入院白细胞计数、完全内科治疗、是否行气管切开、是否出现肺部感染、是否出现应激性溃疡、是否出现消化道感染。
2、以发病后1个月FIM评分为因变量,进行单因素分析筛选出有统计学意义的各个因素为自变量,建立多重线性回归模型,采用逐步向前法,所得到的标准化多重线性回归方程为Y? =-0.085X1+0.216X2-0.235X3-0.368X4-0.093X5-0.113X6-0.173X7 ,P<0.05,有统计学意义。其中Y?为因变量即发病后1个月FIM评分,X1-7为自变量,依次代表入院时收缩压、入院GCS评分、是否有脑室积血、血肿体积、是否出现应激性溃疡、血肿体积扩大、是否出现肺部感染;X的系数为标准化偏回归系数。标准化偏回归系数绝对值的大小代表了其对SICH预后影响的大小。
结论血肿体积、入院GCS评分、脑室是否积血、是否肺部感染、血肿体积扩大、是否发生应激性溃疡、入院时收缩期血压是幕上高血压脑出血预后的关键性预测指标,在临床中应该重视和加强对这些因素的治疗、控制和预防。
Objective To discuss the influencing factors of supratentorial hypertensive intracerebral hemorrhage, and to compare their influence to the prognosis of SICH.
Methods Retrospective analyzed the 324 consecutive cases with SICH admitted in Department of Neurosurgery, Second Affiliated Hospital, Chong Qing University of Medical Science, from January 2001 to January 2006, with general data, symptoms onset, signs on admission, imageological data, therapy strategies and complications as independent variables, and FIM after 1 month as dependent variable. Grouped measurement data used t-test and F-test, continuous mea- surement data used linear correlation analysis, screened the influencing factors of prognosis of SICH, then the valuable influencing factors were filtrated and formulated with multiple regression analysis model and their contribution were compared.
Results
1. The factors with significant influence to the prognosis were screened out with t-test、F-test and linear correlation analysis. These factors include disease history of respiratory system, onset time, vomit, disorder of limbs activity, conscious disturbance, urinary and fecal incontinence, systolic pressure on admission, diastolic pressure on admission, mean arterial pressure on admission, GCS on admission, pupillary diameter, grade of pupillary light reflex, grade of limbs muscle force, pathological reflexes, neck rigidity, side of haematoma, location of haematoma, brain hernia, volume of haematoma, haematoma enlargement, augmented volume after haematoma enlargement, ventricular blood whether or not and its volume, ventricular casting mould, acute hydrocephalus, midline shift on CT scan, blood glucose on admission, leucocyte count on admission, completely medical treatment, incision of trachea, pulmonary infection, stress ulcer, alimentary infection.
2. Multiple regression analysis by forward stepwise were performed. The equation is as follows Y? =-0.085X1+0.216X2-0.235X3- 0.368X4- 0.093X5-0.113X6-0.173X7 , P<0.05, Y? is dependent variable, X1-7 are independent variables which represent systolic pressure on admission, GCS on admission, ventricular blood whether or not, volume of haematoma, stress ulcer, haematoma enlargement, pulmonary infection; the coefficient of X is standardized partial regression coefficient. The absolute value of the standardized partial regression coefficient in the equation denote the difference of such factors’influence to the prognosis of SICH.
Conclusion It is suggested that volume of haematoma, GCS on admission, ventricular blood whether or not, pulmonary infection ,haematoma enlargement, stress ulcer, systolic pressure on admission are the critical predicted index of prognosis of SICH, and we should pay attention and strengthen the treatment, control and prevention to them in clinic.
引文
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