本文選題：高血壓腦出血 + 因素�。� 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的用統(tǒng)計(jì)學(xué)的方法分析HICH患者的性別、年齡、發(fā)病后瞳孔變化（有無腦疝形成）、GCS評(píng)分、中線移位和出血部位、出血是否破入腦室、血腫量和術(shù)后并發(fā)癥如術(shù)后再出血、上消化道出血、肺部感染等因素對(duì)開顱術(shù)后高血壓腦出血患者預(yù)后的影響，并結(jié)合實(shí)際臨床應(yīng)用探討對(duì)改善HICH患者預(yù)后可以采取的措施和方法。 方法回顧性分析大連醫(yī)科大學(xué)附屬第一醫(yī)院神經(jīng)外科一病區(qū)2012年6月至2013年12月以來收治的236例HICH病例,從入院時(shí)患者性別、年齡、GCS評(píng)分、血腫量、瞳孔變化（有無腦疝形成）、中線移位和出血部位、出血是否破入腦室和術(shù)后并發(fā)癥如術(shù)后再出血、上消化道出血、肺部感染等因素對(duì)本病預(yù)后的影響。以患者術(shù)后一個(gè)月的神經(jīng)功能恢復(fù)情況為標(biāo)準(zhǔn)，選用GOS評(píng)分來判斷患者預(yù)后情況。資料統(tǒng)計(jì)方法：?jiǎn)我蛩胤治龇椒ǎ貉芯恐卸诸愖兞坎捎盟母癖碣Y料x2檢驗(yàn),多分類變量資料采用行x列表資料x2檢驗(yàn);統(tǒng)計(jì)數(shù)據(jù)使用SPSS19.0統(tǒng)計(jì)軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果以術(shù)后一月GOS評(píng)分判定236例HICH患者的預(yù)后情況。其中3-5分視為預(yù)后較好組，，預(yù)后較好者共計(jì)142例；以1-2分視為預(yù)后不良組，預(yù)后較差者共計(jì)94例。比較不同患者術(shù)前GCS評(píng)分對(duì)開顱手術(shù)患者預(yù)后有統(tǒng)計(jì)學(xué)意義（χ2=40.311, P＜0.001）；術(shù)前瞳孔是否散大對(duì)開顱手術(shù)患者預(yù)后有統(tǒng)計(jì)學(xué)意義（χ2=10.796,P＜0.05）；不同的術(shù)前血腫量對(duì)開顱手術(shù)患者預(yù)后有統(tǒng)計(jì)學(xué)意義（χ2=25.384,P＜0.001）；患者術(shù)前是否有中線移位及程度對(duì)開顱手術(shù)患者預(yù)后有統(tǒng)計(jì)學(xué)意義（χ2=15.269, P＜0.001）；HICH血腫破入腦室對(duì)開顱手術(shù)患者預(yù)后有統(tǒng)計(jì)學(xué)意義（χ2=14.696，P＜0.001）；術(shù)后是否再出血對(duì)開顱手術(shù)患者預(yù)后有統(tǒng)計(jì)學(xué)意義（χ2=22.763，P＜0.001）；是否肺部感染大對(duì)開顱手術(shù)患者預(yù)后有統(tǒng)計(jì)學(xué)意義（χ2=23.036，P＜0.001）；患者的性別對(duì)開顱手術(shù)患者預(yù)后無統(tǒng)計(jì)學(xué)意義（χ2=1.145,P＞0.05）；患者的年齡對(duì)開顱手術(shù)患者預(yù)后無統(tǒng)計(jì)學(xué)意義（χ2=6.503, P＞0.05）；患者術(shù)前出血部位對(duì)開顱手術(shù)患者預(yù)后無統(tǒng)計(jì)學(xué)意義（χ2=4.489, P＞0.05）；患者術(shù)后是否發(fā)生消化道出血對(duì)開顱手術(shù)患者預(yù)后無統(tǒng)計(jì)學(xué)意義（χ2=0.136P＞0.05）； 結(jié)論綜合分析多種量化因素,影響開顱術(shù)后高血壓腦出血患者預(yù)后的因素眾多,但關(guān)鍵因素為術(shù)前GCS評(píng)分、瞳孔變化、術(shù)后再出血、中線偏移程度、是否破入腦室、肺部感染及顱內(nèi)血腫量，以上因素可以作為評(píng)價(jià)開顱術(shù)后高血壓腦出血患者預(yù)后的指針。從而指導(dǎo)選擇合理的治療手段，協(xié)助臨床醫(yī)師進(jìn)行臨床決策。
[Abstract]:Objective to analyze the gender, age, pupillary changes after onset of HICH by statistical method (whether there were any cerebral hernia or not, midline displacement and bleeding location, whether the hemorrhage broke into the ventricle, the amount of hematoma and postoperative complications such as postoperative rebleeding). The effect of upper gastrointestinal hemorrhage and pulmonary infection on the prognosis of hypertensive intracerebral hemorrhage after craniotomy was discussed. The measures and methods to improve the prognosis of HICH patients were discussed in combination with the practical clinical application. Methods A retrospective analysis was made on 236 cases of HICH admitted from June 2012 to December 2013 in the Department of Neurosurgery, the first affiliated Hospital of Dalian Medical University. Pupillary changes (formation of cerebral hernia, midline displacement and location of hemorrhage, rupture of ventricle and postoperative complications such as postoperative rebleeding, hemorrhage of upper digestive tract, pulmonary infection, etc.) influence on prognosis of the disease. According to the recovery of neurological function one month after operation, GOS score was used to judge the prognosis of the patients. Data statistic method: single factor analysis method: in the study, two classified variables were tested by four-grid table data x2 test, and multi-classified variable data by x-list data x2 test, and statistical data were analyzed by SPSS19.0 statistical software. Results the prognosis of 236 patients with HICH was evaluated by GOS score one month after operation. Among them, 3-5 scores were regarded as the better prognosis group, 142 cases as the better prognosis group, and 94 cases as the poor prognosis group with 1-2 points as the poor prognosis group. Compared with the preoperative GCS scores of different patients, the prognosis of patients undergoing craniotomy was statistically significant (蠂 2: 40.311, P < 0.001), the preoperative pupil dilatation was statistically significant to the prognosis of patients undergoing craniotomy (蠂 ~ (2)) 10.796 (P < 0.05); the quantity of hematoma before operation had a significant effect on the prognosis of patients undergoing craniotomy (蠂 ~ (2)). Statistical significance was found (蠂 ~ 2 ~ 2 ~ (25.384) P < 0.001), whether there was midline shift or not before operation was statistically significant for prognosis of patients undergoing craniotomy (蠂 ~ (2) = 15.269, P < 0.001). The prognosis of patients undergoing craniotomy was statistically significant (蠂 ~ 2 ~ 2 ~ (14.696) P < (0.001)); whether there was another hemorrhage after craniotomy was statistically significant (蠂 ~ (2) = 15.269, P < (0.001)). The prognosis of patients undergoing craniotomy was statistically significant (蠂 ~ 2 + 22.763 P < 0.001); the prognosis of patients undergoing craniotomy was significantly higher than that of patients with pulmonary infection (蠂 ~ (2) = 23.036 (P < 0.001); the sex of patients had no significant difference in the prognosis of patients undergoing craniotomy (蠂 ~ (2)) 1.145 (P > 0.05); the age of the patients had no significant difference in the prognosis of patients undergoing craniotomy (蠂 ~ (2)). There was no significant difference in the prognosis of the patients with craniotomy (蠂 ~ 2 = 6.503, P > 0.05), there was no significant difference in the prognosis of the patients undergoing craniotomy (蠂 ~ 24.489, P > 0.05), and there was no significant difference in the prognosis of the patients with postoperative gastrointestinal bleeding (蠂 ~ (2) 0.136 P > 0.05). Conclusion there are many factors that influence the prognosis of hypertensive intracerebral hemorrhage after craniotomy, but the key factors are preoperative GCS score, pupil change, postoperative rebleeding, midline deviation, and whether or not to break into the ventricle. The above factors can be used to evaluate the prognosis of hypertensive intracerebral hemorrhage after craniotomy. To guide the selection of reasonable treatment methods, to assist clinicians in clinical decision-making.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.34

【參考文獻(xiàn)】

相關(guān)期刊論文 前4條

1 蘇億年;趙丁丁;吳秋濤;陳弼政;羅富華;;高血壓腦出血術(shù)后再出血原因分析及防治對(duì)策[J];當(dāng)代醫(yī)學(xué);2013年18期

2 殷小平,張?zhí)K明,張新江,姜亞平,方思羽,王葦,夏黎明;急性期血腫抽吸引流術(shù)對(duì)腦起保護(hù)作用的機(jī)制研究[J];中風(fēng)與神經(jīng)疾病雜志;2002年06期

3 馬景擰，楊樹源，魯玉華;高血壓腦出血的分型與治療[J];中華神經(jīng)外科雜志;1995年01期

4 王德江;王碩;趙元立;康帥;王梅;劉克軍;趙繼宗;;高血壓腦出血外科治療近期預(yù)后多因素分析[J];中華醫(yī)學(xué)雜志;2005年44期

本文編號(hào)：1800740