自发性颅内出血死亡的多因素回归分析
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摘要
目的探讨自发性颅内出血(spontaneous intracerebral hemorrhage,SIH)患者30 d内死亡的危险因素。方法回顾性分析2012-01至2016-01医院收治的SIH患者324例。30 d内死亡82例,为死亡组,其余242例存活患者为存活组,统计分析两组患者入院时主要临床特征。单因素和多因素logistic回归分析显示格拉斯哥昏迷评分降低、糖尿病、小脑出血、出血量增加和脑室出血等死亡的危险因素。结果与存活组比较,死亡组年龄显著偏大[(54.38±12.47)岁vs(51.73±11.94)岁,P=0.028];高血压病显著增加(68.29%vs 55.79%,P=0.047),;糖尿病显著增加(46.34%vs 27.69%,P=0.002);吸烟率显著增加(35.37%vs 21.07%,P=0.009);小脑出血率显著增高(20.73%vs 8.68%,P=0.003);脑室出血率显著增高(74.39%vs 54.96%,P=0.002);手术率显著降低(20.73%vs 37.19%,P=0.006);出血量显著增多[(110.98±36.96)ml vs(77.04±31.81)ml,t=4.922,P=0.000];格拉斯哥昏迷评分显著降低(7.52±2.70 vs 9.54±2.06,t=4.207,P=0.000)。结论格拉斯哥昏迷评分降低、糖尿病、小脑出血、出血量增加和脑室出血是SIH患者30 d内死亡的危险因素。
Objective To explore the risk factors of 30-day mortality in patients with spontaneous intracranial hemorrhage(SIH). Methods Three hundred and twenty-four patients with SIH admitted to our hospital between January 2012 and January 2016 were retrospectively studied. Eight-two patients who died within 30 days were assigned to a death group,while another 242 survivors were assigned to a survival group. The main clinical features of both groups were observed. Univariate and multivariate logistic regression analysis was used to study such risk factors for death as a decrease of Glasgow coma score,diabetes,cerebellar hemorrhage,an increased amount of hemorrhage and intraventricular hemorrhage. Results When compared with the survival group,patients in the death group had significantly older ages(54. 38 ± 12. 47 vs 51. 73 ± 11. 94,P = 0. 028),a higher rate of hypertension(68. 29% vs55. 79%,P = 0. 047),diabetes(46. 34% vs 27. 69%,P = 0. 002) and of smoking(35. 37% vs 21. 07%,P = 0. 009). The rate of cerebellar hemorrhage increased apparently(20. 73% vs 8. 68%,P = 0. 003),the rate of intraventricular hemorrhage increased significantly(74. 39% vs 54. 96%,P = 0. 002),the surgical rate decreased(20. 73% vs 37. 19%,P = 0. 006),the amount of bleeding increased apparently [(110. 98 ± 36. 96) ml vs(77. 04 ± 31. 81) ml,t = 4. 922,P = 0. 000] and the Glasgow coma score decreased significantly(7. 52 ± 2. 70 vs 9. 54 ± 2. 06,t = 4. 207,P = 0. 000). Conclusions A decrease in Glasgow coma scale,diabetes,cerebellar hemorrhage,an increased amount of hemorrhage and cerebral ventricular hemorrhage are risk factors for 30-day mortality in patients with SIH.
Objective To explore the risk factors of 30-day mortality in patients with spontaneous intracranial hemorrhage(SIH). Methods Three hundred and twenty-four patients with SIH admitted to our hospital between January 2012 and January 2016 were retrospectively studied. Eight-two patients who died within 30 days were assigned to a death group,while another 242 survivors were assigned to a survival group. The main clinical features of both groups were observed. Univariate and multivariate logistic regression analysis was used to study such risk factors for death as a decrease of Glasgow coma score,diabetes,cerebellar hemorrhage,an increased amount of hemorrhage and intraventricular hemorrhage. Results When compared with the survival group,patients in the death group had significantly older ages(54. 38 ± 12. 47 vs 51. 73 ± 11. 94,P = 0. 028),a higher rate of hypertension(68. 29% vs55. 79%,P = 0. 047),diabetes(46. 34% vs 27. 69%,P = 0. 002) and of smoking(35. 37% vs 21. 07%,P = 0. 009). The rate of cerebellar hemorrhage increased apparently(20. 73% vs 8. 68%,P = 0. 003),the rate of intraventricular hemorrhage increased significantly(74. 39% vs 54. 96%,P = 0. 002),the surgical rate decreased(20. 73% vs 37. 19%,P = 0. 006),the amount of bleeding increased apparently [(110. 98 ± 36. 96) ml vs(77. 04 ± 31. 81) ml,t = 4. 922,P = 0. 000] and the Glasgow coma score decreased significantly(7. 52 ± 2. 70 vs 9. 54 ± 2. 06,t = 4. 207,P = 0. 000). Conclusions A decrease in Glasgow coma scale,diabetes,cerebellar hemorrhage,an increased amount of hemorrhage and cerebral ventricular hemorrhage are risk factors for 30-day mortality in patients with SIH.
引文
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[9]翟卫东,钟建卫,王涛,等.高血压脑出血并发大面积脑梗死的危险因素分析[J].武警医学,2014,25(5):497-499.
[10]Chan C L,Ting H W,Huang H T.The incidence,hospital expenditure,and,30 day and 1 year mortality rates of spontaneous intracerebral hemorrhage in Taiwan[J].J Clin Neurosci,2014,21(1):91-94.
[11]Stein M,Luecke M,Preuss M,et al.The prediction of30-day mortality and functional outcome in spontaneous intracerebral hemorrhage with secondary ventricular hemorrhage:a score comparison[J].Acta Neurochir Suppl,2011,112(3):9-11.
[12]Bakhshayesh B,Hosseininezhad M,Seyed Saadat S M,et al.Predicting in-hospital mortality in Iranian patients with spontaneous intracerebral hemorrhage[J].Iran J Neurol,2014,13(4):231-236.
[13]王小刚,高丁,李涛,等.院前应用格拉斯哥昏迷分级评分评估颅脑损伤患者与预后的相关性分析[J].中国临床医生杂志,2015,8(1):36-39.
[14]锁建军.格拉斯哥昏迷评分和血液流变学变化对外伤继发大面积脑梗死的评估价值[J].中国实用神经疾病杂志,2016,19(17):97-98.
[15]Fu J,Chen W J,Wu G Y,et al.Whole-brain 320-detector row dynamic volume CT perfusion detected crossed cerebellar diaschisis after spontaneous intracerebral hemorrhage[J].Neuroradiology,2015,57(2):179-187.
[2]Stein M,Hamann G F,Misselwitz B,et al.In-Hospital mortality and complication rates in surgically and conservatively treated patients with spontaneous intracerebral hemorrhage in central europe:a population-based study[J].World Neurosurg,2016,88(42):306-310.
[3]Ziai W C,Siddiqui A A,Ullman N,et al.Early therapy intensity level(TIL)predicts mortality in spontaneous intracerebral hemorrhage[J].Neurocrit Care,2015,23(2):188-197.
[4]Liu J,Wang D,Lei C,et al.Etiology,clinical characteristics and prognosis of spontaneous intracerebral hemorrhage in children:a prospective cohort study in China[J].J Neurol Sci,2015,358(1-2):367-370.
[5]Hemphill J C,Greenberg S M,Anderson C S,et al.Guidelines for the management of spontaneous intracerebral hemorrhage:a guideline for healthcare professionals from the American heart association/American stroke association[J].Stroke,2015,46(7):2032-2060.
[6]Ferrete A M,Egea J J,Vilches A A,et al.Predictors of mortality and poor functional outcome in severe spontaneous intracerebral hemorrhage:a prospective observational study[J].Med Intensiva,2015,39(7):422-432.
[7]Wang Q,Lin S,Dong W,et al.Characteristics of etiological diagnostic workup across the past 10 years in patients with spontaneous intracerebral hemorrhage in a large general hospital[J].Dev Neurorehabil,2016,19(1):10-16.
[8]Gregson B A,Broderick J P,Auer L M,et al.Individual patient data subgroup meta-analysis of surgery for spontaneous supratentorial intracerebral hemorrhage[J].Stroke,2012,43(6):1496-1504.
[9]翟卫东,钟建卫,王涛,等.高血压脑出血并发大面积脑梗死的危险因素分析[J].武警医学,2014,25(5):497-499.
[10]Chan C L,Ting H W,Huang H T.The incidence,hospital expenditure,and,30 day and 1 year mortality rates of spontaneous intracerebral hemorrhage in Taiwan[J].J Clin Neurosci,2014,21(1):91-94.
[11]Stein M,Luecke M,Preuss M,et al.The prediction of30-day mortality and functional outcome in spontaneous intracerebral hemorrhage with secondary ventricular hemorrhage:a score comparison[J].Acta Neurochir Suppl,2011,112(3):9-11.
[12]Bakhshayesh B,Hosseininezhad M,Seyed Saadat S M,et al.Predicting in-hospital mortality in Iranian patients with spontaneous intracerebral hemorrhage[J].Iran J Neurol,2014,13(4):231-236.
[13]王小刚,高丁,李涛,等.院前应用格拉斯哥昏迷分级评分评估颅脑损伤患者与预后的相关性分析[J].中国临床医生杂志,2015,8(1):36-39.
[14]锁建军.格拉斯哥昏迷评分和血液流变学变化对外伤继发大面积脑梗死的评估价值[J].中国实用神经疾病杂志,2016,19(17):97-98.
[15]Fu J,Chen W J,Wu G Y,et al.Whole-brain 320-detector row dynamic volume CT perfusion detected crossed cerebellar diaschisis after spontaneous intracerebral hemorrhage[J].Neuroradiology,2015,57(2):179-187.