重症高血压脑出血患者临床特征与预后相关性研究

钱露露; 乔力; 曹洋阳; 陶金

doi:10.7619/jcmp.20201127

重症高血压脑出血患者临床特征与预后相关性研究

南京大学医学院附属鼓楼医院 EICU, 江苏南京, 210038

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通讯作者:
陶金, E-mail: 88166394@qq.com

中图分类号: R743.34;R651.1
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出版历程
- 收稿日期: 2020-10-14
- 网络出版日期: 2021-01-26
- 发布日期: 2021-01-27

Study on correlation between clinical features and prognosis of patients with severe hypertensive cerebral hemorrhage

EICU, Gulou Hospital Affiliated to Medical College of Nanjing University, Nanjing, Jiangsu, 210038

摘要

摘要:
目的探讨急诊重症监护病房(EICU)重症高血压脑出血(HICH)患者临床特征与预后的相关性。
方法收集EICU行手术治疗的154例重症HICH患者的临床资料，根据出院后3个月格拉斯哥预后评分(GOS)分级将患者分为预后不良组(GOS Ⅰ、Ⅱ、Ⅲ级)74例和预后良好组(GOS Ⅳ、Ⅴ级)80例。应用脑室改良Graeb量表(mGS)评分评价患者脑出血严重程度，并收集患者年龄、性别、手术方式、脑室外引流、梗阻性脑积水、脑疝、中脑导水管结构和术后第1天平均颅内压波幅(MWA)、压力反应指数(PRx)的资料，通过Logistic回归分析和受试者工作特征(ROC)曲线分析预后的影响因素及mGS评分、MWA、PRx对预后的预测效能。
结果多因素Logistic回归分析结果显示，年龄、脑疝、脑积水、MWA、PRx为预后的独立影响因素(P < 0.05或P < 0.01)。ROC曲线分析结果表明, mGS评分、MWA、PRx联合应用对预后的预测效果优于单独指标预测效果。
结论年龄、脑疝、脑积水、MWA、PRx为重症HICH患者预后的影响因素，联合应用mGS评分、MWA、PRx可以有效预测重症HICH患者预后情况。
- 高血压脑出血 /
- 预后 /
- 改良Graeb量表评分 /
- 平均颅内压波幅 /
- 压力反应指数
Abstract:
Objective To investigate correlation between clinical features and prognosis of patients with severe hypertensive intracerebral hemorrhage (HICH) in emergency intensive care unit (EICU).
Methods Clinical data of 154 patients with severe HICH who underwent surgical treatment in EICU was retrospectively collected. According to grading of Glasgow Outcome Scale (GOS) score 3 months after discharge, these patients were divided into poor prognosis group (including patients with grading of GOS Ⅰ, Ⅱ and Ⅲ, n=74) and good prognosis group (including patients with grading of GOS Ⅳ and Ⅴ, n=80). The modified Graeb Scale (mGS) score was used to evaluate the severity of cerebral hemorrhage in patients, and the patient′s age, gender, surgical methods, ventricular drainage, obstructive hydrocephalus, cerebral herniation, midbrain aqueduct structure, and mean wave amplitude (MWA) on the first day after surgery and pressure response index (PRx) were collected. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were used to analyze the prognostic factors, and the effectiveness for predicting prognosis was evaluated by mGS, MWA, and PRx.
Results Multivariate Logistic regression analysis showed that age, brain herniation, hydrocephalus, MWA, PRx were independent influencing factors for prognosis (P < 0.05 or P < 0.01). ROC curve analysis showed that the combined application of mGS score, MWA, and PRx had better efficacy in predicting prognosis than one indicator alone.
Conclusion Patients′age, cerebral herniation, hydrocephalus, MWA, PRx are the prognostic influencing factors of patients with severe hypertensive cerebral hemorrhage. The combined application of mGS score, MWA and PRx can effectively predict the prognosis of patients with severe HICH.
- hypertensive cerebral hemorrhage /
- prognosis /
- modified Graeb scale score /
- average intracranial pressure amplitude /
- pressure response index

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图 1 mGS评分、MWA、PRx单独与联合应用对预后的预测价值

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表 1 mGS评分评估细则分

部位	无出血	出血量占脑室比 ≤25%	出血量占脑室比 >25%~50%	出血量占脑室比 >50%~75%	出血量占脑室比 >75%	合并脑室扩张
四脑室	0	2	2	4	4	1
三脑室	0	2	2	4	4	1
左侧颞角	0	1	1	2	2	1
右侧颞角	0	1	1	2	2	1
左侧枕角	0	1	1	2	2	1
右侧枕角	0	1	1	2	2	1
左侧脑室	0	1	2	3	4	1
右侧脑室	0	1	2	3	4	1
出血量占脑室比: 每个脑室的出血量占脑室实际容量的比率。

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表 2 2组mGS评分、MWA和PRx比较(x±s)

组别	n	mGS评分/分	MWA/(mmHg/h)	PRx
预后良好组	80	8.14±4.23	4.78±2.10	0.24±0.05
预后不良组	74	6.94±2.03^**	10.36±1.56^**	0.27±0.06^*
mGS: 改良Graeb量表; MWA: 平均颅内压波幅; PRx: 压力反应指数。与预后良好组比较, P < 0.05, *P < 0.01。

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表 3 HICH患者术后预后不良的单因素分析[n(%)]

相关因素		n	预后不良	χ²	P
年龄	<60岁	64	24(37.50)	4.234	0.040
	≥60岁	90	50(55.56)
性别	男	86	42(48.84)	0.048	0.826
	女	68	32(47.06)
手术方式	微创手术	81	39(48.15)	0.001	0.980
	开颅手术	73	35(47.95)
中脑水管结构	清晰	13	6(46.15)	0.020	0.886
	不清晰	141	68(48.23)
脑疝	是	47	31(65.96)	8.688	0.003
	否	107	43(40.19)
脑积水	是	43	32(74.42)	5.721	0.017
	否	111	42(37.84)
脑室外引流	是	105	48(45.71)	0.722	0.395
	否	49	26(53.06)
MWA	≤5 mmHg/h	97	38(39.18)	4.168	0.041
	>5 mmHg/h	57	36(63.16)
PRx	≤0.25	89	36(40.45)	4.057	0.044
	>0.25	65	38(58.46)
MWA: 平均颅内压波幅; PRx: 压力反应指数。

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表 4 HICH手术患者预后的多因素Logistic回归分析

因素	OR	P	95%CI
年龄	4.499	0.047	1.018~19.881
脑疝	4.835	0.038	1.088~21.475
脑积水	5.724	0.017	1.477~25.652
MWA	5.325	0.021	1.293~22.349
PRx	5.841	0.003	1.802~18.932

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参考文献(15)

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重症高血压脑出血患者临床特征与预后相关性研究

通讯作者: 陶金, E-mail: 88166394@qq.com

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Study on correlation between clinical features and prognosis of patients with severe hypertensive cerebral hemorrhage

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通讯作者:
陶金, E-mail: 88166394@qq.com