本文選題：腦室出血 + 腦室外引流��； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：背景和目的： 腦室出血(Intraventricular hemorrhage,IVH)是一種神經(jīng)外科臨床中極為常見的危急癥，研究資料表明其具有較高的發(fā)病率，且預(yù)后多不良。近些年相關(guān)的臨床研究表明，在腦室出血的早期快速清除腦室內(nèi)的積血并將其引流到體外，逐漸將血性腦脊液更新至正常水平，疏通腦脊液循環(huán)通道，保證腦積液的正常循環(huán)，不僅能夠迅速解除血凝塊因占位效應(yīng)對(duì)周圍腦組織的壓迫性損傷，而且還能減少積血的各種代謝產(chǎn)物所介導(dǎo)的腦組織水腫及化學(xué)性損傷。其中以腦室外引流(external ventricular drainage,EVD)術(shù)為核心的外科治療手段的有效性已經(jīng)被廣泛認(rèn)可，但國(guó)內(nèi)EVD開展的時(shí)間并不長(zhǎng)，且各個(gè)治療中心預(yù)后不一，有關(guān)腦室出血預(yù)后的影響因素及影響力大小缺乏系統(tǒng)、全面的研究。本課題通過對(duì)腦室出血外科治療后的病例進(jìn)行回顧性研究，以探討影響腦室出血外科治療預(yù)后的相關(guān)因素，以及各個(gè)影響因素影響力的大小，以便為臨床提供更好的治療方法和預(yù)后判斷，為以后的臨床治療決策提供相關(guān)的科學(xué)依據(jù)。 資料和方法： 本次研究將2011年10月至2013年11月期間，于吉林大學(xué)中日聯(lián)醫(yī)院神經(jīng)外一科住院治療的所有腦室出血患者（共387例）的病歷資料，按照病例納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)最終將153例腦室出血病例納入本次課題研究。將患者入院時(shí)的一般情況、發(fā)病癥狀、一般查體及神經(jīng)系統(tǒng)檢查、影像學(xué)檢查資料、外科治療方式、所繼發(fā)的并發(fā)癥等確定為自變量（其中部分變量進(jìn)行數(shù)值化處理），以患者治療三個(gè)月后斯堪的納維亞腦卒中量表（ScandinavianStrokeScale,SSS）評(píng)分作為因變量。先采用單因素分析篩選出對(duì)預(yù)后有影響的相關(guān)單個(gè)因素，再以單因素分析所得出的與腦室出血（IVH）外科治療預(yù)后有統(tǒng)計(jì)學(xué)意義的因素為自變量，，以3個(gè)月后患者SSS評(píng)分為因變量，進(jìn)行多元線性邏輯回歸分析，得出各因素對(duì)腦室出血外科治療預(yù)后影響的大小。 結(jié)果： 通過單因素分析篩選，其中有9個(gè)因素對(duì)腦室出血外科治療預(yù)后有明顯的影響（P＜0.05）。后通過多元線性邏輯回歸模型結(jié)果顯示：年齡、入院時(shí)血糖值、腦室內(nèi)積血量、入院時(shí)收縮壓與預(yù)后具有負(fù)相關(guān)性，即年齡越大、入院時(shí)血糖越高、腦室內(nèi)積血量越多、入院時(shí)收縮壓越高，預(yù)后越差；入院時(shí)GCS評(píng)分(Glasgow Coma Scale,GCS評(píng)分)、是否第三及第四腦室積血、是否發(fā)生急性腦積水、是否發(fā)生應(yīng)激性潰瘍、是否發(fā)生肺部感染與預(yù)后具有正相關(guān)性，即術(shù)前GCS評(píng)分越低、第三及第四腦室內(nèi)積血越多、越早發(fā)生急性腦積水、應(yīng)激性潰瘍?cè)絿?yán)重，肺部感染越嚴(yán)重，預(yù)后越差。 結(jié)論： 1.單因素分析表明19項(xiàng)納入本研究的影響因素中有9項(xiàng)對(duì)腦室出血外科治療預(yù)后有影響，包括：年齡、入院時(shí)GCS評(píng)分、側(cè)腦室及第三四腦室積血、側(cè)腦室積血、入院時(shí)血糖值、急性腦積水、入院時(shí)收縮壓、應(yīng)激性潰瘍、肺部感染。 2.根據(jù)多元線性邏輯回歸方程顯示，各個(gè)因素對(duì)腦室出血外科治療預(yù)后影響力的大小從高到低依次是：側(cè)腦室及第三四腦室積血、側(cè)腦室積血量、肺部感染、急性腦積水、入院時(shí)GCS評(píng)分、應(yīng)激性潰瘍、入院時(shí)收縮壓、年齡、入院時(shí)血糖值。而且，各影響因素有累加效應(yīng)。
[Abstract]:Background and purpose:
Intraventricular hemorrhage (IVH) is a very common crisis in Department of neurosurgery. Research data show that it has high incidence and poor prognosis. The spinal fluid is updated to the normal level and dredges the circulation channel of cerebrospinal fluid to ensure the normal circulation of the hydrocephalus. It can not only quickly relieve the compression damage of the blood clot due to the occupying effect on the surrounding brain tissue, but also reduce the brain tissue edema and chemical damage mediated by the various metabolites of the hematoma. Among them, the external drainage of the brain (external VE) is used. The effectiveness of ntricular drainage, EVD) as the core of surgical treatment has been widely recognized, but the time of the domestic EVD is not long, and the prognosis of each treatment center is not one. The factors affecting the prognosis of the ventricle hemorrhage and the size of the influence are lack of a systematic and comprehensive study. A retrospective study was conducted to explore the related factors affecting the prognosis of surgical treatment of ventricular hemorrhage, as well as the influence of various factors, so as to provide better therapeutic methods and prognostic judgments for clinical treatment, and to provide a scientific basis for future clinical treatment decisions.
Information and methods:
In this study, from October 2011 to November 2013, the medical records of all the patients with cerebral hemorrhage (387 cases) hospitalized at the Department of Neurology in the Jilin University, China and Japan Union Hospital (a total of 153 cases of cerebral hemorrhage were included in this study. The general situation of admission to the hospital, the onset of the disease, was taken into account. " Symptoms, general examination and nervous system examination, imaging examination data, surgical treatment, and secondary complications were determined as independent variables (part of the variables were numerically treated), and the Scandinavia Stroke Scale (ScandinavianStrokeScale, SSS) score was used as the dependent variable after three months of treatment. The factors related to prognosis were screened out, and the factors of statistical significance in the surgical treatment of ventricular hemorrhage (IVH) were statistically significant in the single factor analysis. The multivariate linear logistic regression analysis was carried out with the SSS score of 3 months later, and the effects of various factors on the prognosis of surgical treatment of ventricular hemorrhage were obtained. Size.
Result:
Through single factor analysis, 9 factors had significant influence on the prognosis of surgical treatment of ventricular hemorrhage (P < 0.05). The results of multiple linear logistic regression showed that age, blood sugar, intraventricular volume of blood, systolic blood pressure at admission and prognosis were negatively correlated, that is, the older the age, the higher the blood glucose at admission, the ventricles of the brain. The more the volume of inner product, the higher the systolic blood pressure, the worse the prognosis, the GCS score (Glasgow Coma Scale, GCS score) at admission, whether third and the four ventricle accumulated blood, whether there is acute hydrocephalus, whether there is a stress ulcer, whether there is a positive correlation between the pulmonary infection and the prognosis, that is, the lower the preoperative GCS score, third and the four brain chamber. The more blood is accumulated, the earlier the incidence of acute hydrocephalus is, the more serious the stress ulcer is, the more serious the lung infection is, the worse the prognosis.
Conclusion:
1. single factor analysis showed that 9 of the 19 factors involved in the study had an impact on the prognosis of surgical treatment of ventricular hemorrhage, including age, GCS score at admission, lateral ventricle and three or four ventricle accumulation, lateral ventricle accumulation, blood glucose value at admission, acute hydrocephalus, systolic pressure at admission, stress ulcers, and pulmonary infection.
2. according to the multiple linear logistic regression equation, the influence of various factors on the prognosis of surgical treatment of ventricular hemorrhage from high to low were: lateral ventricle and three or four ventricle accumulation, lateral ventricle accumulation, pulmonary infection, acute hydrocephalus, GCS score, stress ulcer, systolic pressure at admission, age, and blood glucose at admission. Moreover, the influence factors have cumulative effect.
【學(xué)位授予單位】：吉林大學(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6條

1 張昱;腦出血的病理改變及病理生理過程[J];中國(guó)現(xiàn)代神經(jīng)疾病雜志;2005年02期

2 張昱;劉多三;;高血壓腦出血病理組織學(xué)改變與CT影相對(duì)照研究[J];中風(fēng)與神經(jīng)疾病雜志;1986年03期

3 林勇;胡濤;;影響自發(fā)性腦出血患者預(yù)后的相關(guān)因素分析(附196例報(bào)告)[J];中國(guó)臨床神經(jīng)外科雜志;2011年06期

4 宋治,資曉宏,范學(xué)軍,涂秋云,朱海霞,張如旭,李柳紅,袁毅,侯德仁,楊期東;修改Graeb評(píng)分標(biāo)準(zhǔn)預(yù)測(cè)腦室積血并發(fā)急性梗阻性腦積水[J];中華神經(jīng)科雜志;2001年05期

5 楊維,李成林,張乃崇,蒯增芝;1863 例神經(jīng)外科住院患者醫(yī)院感染回顧性分析[J];中華醫(yī)院感染學(xué)雜志;1997年02期

6 劉國(guó)棟;毛錦寧;程遠(yuǎn);馬穎;陳維福;張宣文;;腦室出血預(yù)后影響因素的多元線性分析[J];重慶醫(yī)科大學(xué)學(xué)報(bào);2006年02期

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