Zhongguo cuzhong zazhi (Jul 2018)
幕上高血压性脑出血微创颅内血肿抽吸引流术1年预后相关因素分析 Analysis of Related Factors of 1-year Outcome of Minimally Invasive Surgery in Supratentorial Spontaneous Intracerebral Hemorrhage
Abstract
目的 探讨幕上高血压性脑出血（intracerebral h emorrhage，ICH）微创颅内血肿抽吸引流术1年预后及 其相关因素。 方法 收集2014年1月-2016年8月就诊的进行微创颅内血肿抽吸引流术的幕上高血压性ICH患者。记 录患者人口学特征等基本信息、临床信息、手术治疗信息及1年改良Rankin量表（modified Rankin scale， mRS）评分。主要临床结局为1年预后不良，定义为1年mRS>3分。用多因素Logistic回归分析1年预后不 良的相关因素。 结果 研究共纳入117例完成微创颅内血肿抽吸引流术的幕上高血压性I C H患者。平均年龄 （56.5±12.5）岁，基线血肿体积（59.0±28.5）ml。59例（50.4%）ICH患者1年预后不良。多因素Logistic 回归分析显示，基线血肿体积20～50 ml[比值比（odds ratio，OR）0.161，95%置信区间（confidence interval，CI）0.034～0.748，P =0.020]、年龄≤60岁（OR 0.169，95%CI 0.055～0.515，P =0.002）是1年预 后不良的保护性因素。 结论 基线血肿体积和年龄是幕上高血压性ICH微创颅内血肿抽吸引流术1年预后的独立影响因素， 该结论为选择微创颅内血肿抽吸引流术适宜人群提供依据。 Abstract: Objective To study 1-year clinical outcomes after minimally invasive catheter evacuation followed by urokinase for clot removal in patients with acute supratentorial spontaneous intracerebral hemorrhage (ICH) and determine the factors associated with the 1-year outcome. Methods Supratentorial spontaneous ICH patients who had undergone minimally invasive catheter evacuation followed by urokinase for clot removal during January 2014 and September 2016 were collected . Patients' demographic and clinical information, surgery information and one-year modified Rankin scale (mRS) were recorded. The main clinical outcome was poor outcome, defined as mRS score >3 at 1 year. The multi-factor logistic regression analysis was used to determine factors associated with 1-year clinical outcome after ICH. Results A total of 117 patients with supratentorial spontaneous ICH and having undergone minimally invasive surgery were enrolled in the study. The mean age was (56.5±12.5) years and the mean baseline hematoma volume was (59.0±28.5) ml. 59 (50.4%) ICH patients had 1-year poor outcome after surgery. Multi-factor Logistic regression analysis revealed that baseline hematoma volume 20-50 ml [odds ratio (OR) 0.161, 95% confidence interval (CI) 0.034-0.748, P =0.020] and age≤60 years (OR 0.169, 95%CI 0.055-0.515, P =0.002) were independent protective factors of 1-year poor outcome. Conclusion Baseline hematoma volume and age were independent predictors of 1-year outcome in acute ICH patients who had undergone minimally invasive surgery, which could allow better selection of ICH patients appropriate for minimally invasive surgery.
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