【摘要】 目的探讨高血压性脑干出血的临床特点和预后。方法对103例高血压性脑干出血患者的临床资料进行回顾性分析,以治疗或随访3个月后的日常生活活动能力(ADL)分级作为预后评价指标。采用卡方检验对可能影响患者预后的因素(包括性别、年龄、出血量、出血部位、出血破入脑室、GCS评分、瞳孔变化、并发症及收缩压和舒张压)进行单因素分析,对其中差异有统计学意义(P<0.05)者采用有序多分类Logistic回归方法进行多因素分析,寻找影响患者预后的主要因素;并对出血量因素进行受试者工作特征曲线(ROC)分析。结果 103例患者预后为ADLⅠ级14例、ADLⅡ级10例、ADLⅢ级11例、ADLⅣ级15例、ADL V级7例、ADLⅥ级46例。单因素分析结果显示出血量、出血部位、出血破入脑室、GCS评分、瞳孔变化、并发症及入院时收缩压等因素差异有统计学意义(P<0.05),进一步多因素分析显示出血量、出血部位和并发症是影响患者预后的重要因素(均P<0.05)。ROC曲线分析显示死亡风险的出血量阈值为≤6 mL。结论高血压性脑干出血的预后较差,其预后主要取决于出血量、出血部位和并发症。更多还原

【Abstract】 Objective To investigate the clinical characteristics and prognostic factors of hypertensive brain stem hemorrhage.Methods The clinical data of 103 patients with hypertensive brain stem hemorrhage were analyzed retrospectively.The activity of daily living(ADL) after 3 months of treatment was used as the outcome measure of prognostic evaluation.The following factors,gender,age,hemorrhage volume,bleeding site,bleeding with breaking into the ventricles,GCS scores,pupil changes,complications,and systolic and diastolic blood pressures,were considered to potentiallg affect the prognosis of the patients.Univariate analysis were performend by chi-square test.For these factors with statistical significance difference(P<0.05),the multivariate analysis were performend by ordinal multinomial Logistic regression in order to find out the main factors influencing the prognosis.Then the factor of hemorrhage volume was analyzed by receiver operating characteristic curve(ROC).Results After 3 months,the prognosis was as follows. 14 patients got with ADL Ⅰ,10 cases with ADL Ⅱ,11 cases with ADL Ⅲ,15 cases with ADL Ⅳ,7 cases with ADL Ⅴ and 46 cases with ADL Ⅵ.The univariate analysis result showed that these factors might influence the outcome:hemorrhage volume,bleeding site,bleeding with breaking into the ventricles,GCS scores,changes of pupil,complications and systolic pressure(P<0.05).Further multivariate analysis revealed that hemorrhage volume,bleeding site and complications were important prognostic factors(P<0.05).The ROC results showed:the risk of death of patients was low if the amount of hemorrhage was no more than 6 mL.Conclusions The prognosis of hypertensive brainstem hemorrhage is poor,which mainly depends on the amount of bleeding,bleeding site and complications.更多还原