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中华神经创伤外科电子杂志

中华神经创伤外科电子杂志 ›› 2017, Vol. 03 ›› Issue (06) : 351 -354. doi: 10.3877/cma.j.issn.2095-9141.2017.06.007

所属专题： 经典病例； 文献；

临床研究

200例丘脑基底节区高血压脑出血患者手术治疗效果及预后分析
于泽奇,1, 江继鹏1, 董晓煜2, 王婧怡3   
  1. 1. 300162　天津，武警后勤学院附属医院脑科医院
    2. 100621　北京，北京武警总队三支队卫生队
    3. 300309　天津，武警后勤学院附属医院检验科
  • 收稿日期:2017-05-08 出版日期:2017-12-15
  • 通信作者: 于泽奇
  • 基金资助:
    国家自然科学基金项目(31200809); 武警部队后勤科研项目(WJHQ2012-20); 军队技术产品研究重大项目(AWS15J001); 天津市科技计划项目(15ZXLCSY00040)

Analysis of surgical effect and prognosis of 200 patients with hypertensive cerebral hemorrhage in thalami basal ganglia

Zeqi Yu,1, Jipeng Jiang1, Xiaoyu Dong2, Jingyi Wang3   

  1. 1. Neurology and Neurosurgery Hospital, Affiliated Hospital of Logistics College of Chinese People’s Armed Police Force, Tianjin 300162, China
    2. Medical Unit of Three Detachment of Beijing Armed Police Corps, Beijing 100621, China
    3. Department of Clinical Laboratory, Logistics University of Chinese People’s Armed Police Force, Tianjin 300309, China
  • Received:2017-05-08 Published:2017-12-15
  • Corresponding author: Zeqi Yu
  • About author:
    Corresponding author: Yu Zeqi, Email:
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于泽奇, 江继鹏, 董晓煜, 王婧怡. 200例丘脑基底节区高血压脑出血患者手术治疗效果及预后分析[J/OL]. 中华神经创伤外科电子杂志, 2017, 03(06): 351-354.

Zeqi Yu, Jipeng Jiang, Xiaoyu Dong, Jingyi Wang. Analysis of surgical effect and prognosis of 200 patients with hypertensive cerebral hemorrhage in thalami basal ganglia[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2017, 03(06): 351-354.

目的

探讨200例丘脑基底节区高血压脑出血患者手术治疗效果及预后。

方法

选取自2014年11月至2016年11月武警后勤学院附属医院脑科医院收治的200例手术治疗丘脑基底节区高血压脑出血患者的临床资料，将恢复良好、轻度残疾患者归为预后良好组，将重度残疾、植物生存、死亡患者归为预后不良组，分析手术预后的影响因素。

结果

在200例患者中，49例恢复良好（24.5%），66例轻度残疾（33.0%），46例重度残疾（23.0%），24例植物生存（12.0%），15例死亡（7.5%）。预后良好组年龄<50岁、手术时间≤6 h、血肿量为30~50 ml、术前GCS评分≥8分的几率高于预后不良组，出血破入脑室、术后并发症的几率低于预后不良组，差异均具有统计学意义（P<0.05）；Logistic回归分析显示，手术时机、血肿量、术前GCS评分、出血破入脑室是影响丘脑基底节区高血压脑出血患者手术预后的独立危险因素。

结论

手术是临床治疗丘基底节区高血压脑出血患者的有效手段，手术时机、血肿量、术前GCS评分、出血破入脑室是影响手术预后的重要因素。

关键词: 基底节区, 高血压脑出血, 预后, 影响因素
Objective

To explore surgical effect and prognosis of 200 patients with hypertensive cerebral hemorrhage in thalami basal ganglia.

Methods

A retrospective analysis of clinical data was carried out in 200 patients with hypertensive cerebral hemorrhage in thalami basal ganglia who received surgical treatment in the Affiliated Hospital of Logistics College of Chinese People’s Armed Police Force from November 2014 to November 2016. Patients with good recovery+mild disability were classed as good prognosis group, and patients with severe disability+vegetative state+death were classed as poor prognosis group. Finally, influencing factors of operative prognosis were analyzed.

Results

In 200 patients, 49 cases had good recovery (24.5%), 66 cases were mild disability (33.0%), 46 cases were severe disability (23.0%), 24 cases were vegetative state (12.0%), 15 cases died (7.5%). Incidence of age<50 years old, operation time≤6 h, volume of hematoma 30-50 ml, preoperative GCS scores≥8 in good prognosis group were significantly higher than poor prognosis group, incidence of hemorrhage with intraventricular hemorrhage and postoperative complications were significantly lower than poor prognosis group (P<0.05); Logistic regression analysis showed that operation time, volume of hematoma, preoperative GCS scores, hemorrhage with intraventricular hemorrhage were independent risk factors which affected the operative prognosis of patients with hypertensive cerebral hemorrhage in thalami basal ganglia.

Conclusion

Surgery is an effective method to treat hypertensive cerebral hemorrhage in thalami basal ganglia in clinic. Operation time, volume of hematoma, preoperative GCS scores, and hemorrhage with intraventricular hemorrhage are important influencing factors which affect operative prognosis.

Key words: Basal ganglia, Hypertensive cerebral hemorrhage, Prognosis, Influencing factor
表1 丘脑基底节脑出血预后影响因素的单因素分析[例（%）]
项目 ? 预后良好(n=115) 预后不良(n=85) χ2值 P值
年龄 <50岁 44(38.26) 10(11.76) 17.410 0.001
≥50岁 71(61.74) 75(88.23)
性别 男 72(62.61) 51(60.00) 0.032 0.870
女 43(37.39) 29(40.00)
手术时机 ≤6 h 99(86.09) 44(51.76) 28.252 0.001
6~24 h 16(13.91) 41(48.24)
血肿量 30~50 ml 74(64.35) 28(31.94) 19.287 0.001
>50 ml 41(35.65) 57(67.06)
术前GCS评分 ≥8分 69(60.00) 23(27.06) 15.639 0.001
<8分 46(40.00) 52(61.18)
出血破入脑室 是 29(25.22) 51(60.00) 24.644 0.001
否 86(74.78) 34(40.00)
表2 丘脑基底节脑出血预后影响因素的Logistic回归分析
项目 Wald值 P值 OR值 95%置信区间
年龄 5.721 0.010 4.653 2.181~9.933
手术时机 2.683 0.031 5.132 2.418~7.354
血肿量 4.618 0.010 5.034 1.432~9.801
术前GCS评分 3.979 0.010 4.227 1.023~7.452
出血破入脑室 3.190 0.022 2.119 0.291~5.350
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