高血壓腦出血手術(shù)治療的預(yù)后影響因素分析
發(fā)布時間：2019-06-02 15:45
【摘要】：目的:了解高血壓腦出血(Hypertensiveintracerebral hemorrhage,HICH)的一般臨床特點(diǎn),運(yùn)用統(tǒng)計學(xué)方法對HICH患者的年齡、性別、入院收縮壓(SBP)、入院血糖、術(shù)后肺部感染情況、術(shù)前瞳孔大小、GCS昏迷評分、出血部位、中線移位、腦出血量、手術(shù)時機(jī)、出血破入腦室、是否發(fā)生二次出血等因素對手術(shù)后高血壓腦出血患者預(yù)后的影響。對能改善HICH患者預(yù)后的相關(guān)因素,可給予臨床干預(yù)。采用科學(xué)而合理的決策以期改善HICH患者預(yù)后。方法:選擇收集皖南醫(yī)學(xué)院第一附屬醫(yī)院神經(jīng)外科2015.01—2016.10期間收住入院的118例HICH患者,并對其術(shù)前影像學(xué)資料、相關(guān)臨床數(shù)據(jù)、術(shù)后資料等行回顧分析,包括患者的年齡、入院收縮壓(SBP)、術(shù)后是否發(fā)生肺部感染、瞳孔大小、血糖高低、GCS昏迷評分、出血部位、中線移位情況、腦出血量、手術(shù)時機(jī)、是否發(fā)生二次出血等十三項因素。根據(jù)格拉斯哥預(yù)后評分(GOS)來判斷患者術(shù)后1月的恢復(fù)情況,可以量化評判患者術(shù)后的情況。統(tǒng)計資料的分析方法:采用單因素分析方法:對所選數(shù)據(jù)運(yùn)用SPSS16.0軟件,根據(jù)卡方檢驗(χ~2檢驗)進(jìn)行分析。結(jié)果:根據(jù)GOS評分來判斷118例高血壓腦出血病人術(shù)后1個月后的恢復(fù)情況。評分在3-5范圍的病人歸為預(yù)后良好,預(yù)后良好有71人;評分在1-2分范圍的病人歸為預(yù)后不良,預(yù)后不良47人。其中:1.高血壓腦出血病人入院GCS昏迷評分對術(shù)后恢復(fù)情況的影響(χ~2=18.514,P=0.000);2.術(shù)前血糖值的高低對HICH病人的預(yù)后影響(χ~2=7.212,P=0.007);3.顱內(nèi)出血量對術(shù)后HICH病人的預(yù)后影響(χ~2=10.909,P=0.004);4.術(shù)前瞳孔的改變對手術(shù)后病人的預(yù)后影響(χ~2=10.872,P=0.001);5.術(shù)前收縮壓的高低對HICH患者預(yù)后的影響(χ~2=8.397,P=0.004);6.中線是否發(fā)生移位對經(jīng)外科治療患者的預(yù)后影響(χ~2=4.604,P=0.032);7.發(fā)生HICH后血腫破入腦室對術(shù)后患者的預(yù)后影響(χ~2=6.363,P=0.012);8.HCIH病人術(shù)后是否發(fā)生二次出血對患者的預(yù)后影響(χ~2=6.894,P=0.009);9.HICH患者術(shù)后發(fā)生肺部感染對其預(yù)后影響(χ~2=10.273,P=0.001);10.不同手術(shù)時機(jī)的選擇對開顱術(shù)后患者的預(yù)后影響(χ~2=5.158,P=0.076);11.性別對開顱術(shù)后患者的預(yù)后影響(χ~2=0.014,P=0.905);12.年齡對開顱手術(shù)后HCIH病人預(yù)后影響(χ~2=4.303,P=0.116);13.根據(jù)影像資料HICH病人術(shù)前出血部位對術(shù)后預(yù)后影響(χ~2=6.575,P=0.037)。結(jié)論:HICH患者經(jīng)過開顱手術(shù)后,影響其預(yù)后的因素多樣且復(fù)雜,通過對臨床資料和數(shù)據(jù)分析,可以得出較為合理的結(jié)論。在所統(tǒng)計的各種因素中:HICH病人入院收縮壓(SBP)的高低、術(shù)后是否發(fā)生肺部感染、瞳孔大小、GCS昏迷評分、血腫位置、中線有無移位、腦出血量、術(shù)后是否二次出血、出血是否破入腦室、血糖高低等因素有統(tǒng)計學(xué)意義。而HICH病人年齡、性別以及手術(shù)時機(jī)的選擇,經(jīng)分析可知并非影響預(yù)后的決定性因素。為此,在臨床中若能對能提高HICH患者預(yù)后的相關(guān)因素,給予適當(dāng)?shù)奶幚碛锌赡苁笻ICH病人受益�？茖W(xué)而合理的決策對改善HICH患者預(yù)后,降低其死亡率和致殘率,提高生存率和生活質(zhì)量將有很大的幫助。
[Abstract]:Objective: To study the general clinical characteristics of hypertensive cerebral hemorrhage (HICH). The age, sex, systolic blood pressure (SBP), admission blood sugar, postoperative pulmonary infection, pre-operative pupil size, GCS coma score, bleeding position and midline shift of HICH were studied by statistical method. The effect of post-operative hypertensive cerebral hemorrhage on the prognosis of patients with hypertensive cerebral hemorrhage after operation, such as the amount of cerebral hemorrhage, the timing of operation, the bleeding of the hemorrhage into the ventricle, and the occurrence of secondary hemorrhage. Clinical intervention can be given to factors that can improve the prognosis of HICH patients. Scientific and reasonable decision-making is used to improve the prognosis of HICH patients. Methods:118 HICH patients admitted to the hospital during the neurosurgery of the first Affiliated Hospital of Anhui Medical College during the period of 2015.01-2016.10 were selected, and the preoperative imaging data, relevant clinical data and postoperative data were retrospectively analyzed, including the age of the patient, systolic blood pressure (SBP), Thirteen factors such as pulmonary infection, pupil size, blood glucose level, GCS coma score, hemorrhage site, midline shift, cerebral hemorrhage, operation timing, and whether secondary hemorrhage occurred after operation. According to the Glasgow Outcome Score (GOS), the patient's recovery in January was determined, and the post-operative condition of the patient could be quantified. Analysis method of statistical data: using the single factor analysis method: using the SPSS16.0 software for the selected data, and analyzing according to the chi-square test (1-2 test). Results: The recovery of 118 patients with hypertensive cerebral hemorrhage after 1 month after operation was determined according to the GOS score. Patients with a score of 3-5 were classified as good prognosis and good prognosis; patients with a score of 1-2 were classified as poor prognosis and poor prognosis. In which:1. The effect of GCS (2 = 18.514, P = 0.000) on the post-operative recovery of patients with hypertensive cerebral hemorrhage was affected (P = 18.514, P = 0.000). The effect of preoperative blood glucose level on the prognosis of HICH patients (1 ~ 2 = 7.212, P = 0.007); The effect of intracranial hemorrhage on the prognosis of HICH patients after operation (1 ~ 2 = 10.909, P = 0.004); The effect of pre-operative pupillary change on the prognosis of patients after operation (1-2 = 10.872, P = 0.001);5. The effect of preoperative systolic blood pressure on the prognosis of HICH patients (1 ~ 2 = 8.397, P = 0.004); Whether the median line is displaced is affected by the outcome of the surgical treatment (1-2 = 4.604, P = 0.032);7. The prognosis of patients with HICH after HICH was affected (1 ~ 2 = 6.363, P = 0.012).8. The effect of secondary hemorrhage on the prognosis of HCIH patients after operation (1 ~ 2 = 6.894, P = 0.009);9. The effect of postoperative pulmonary infection on the prognosis of HICH (1 ~ 2 = 10.273, P = 0.001);10. The choice of time of operation on the prognosis of the patients after craniotomy (1-2 = 5.158, P = 0.076);11. The effect of gender on the prognosis of patients after craniotomy (1-2 = 0.014, P = 0.905); The effect of age on the prognosis of HCIH patients after craniotomy (1-2 = 4.303, P = 0.116);13. The effect of pre-operative bleeding on the prognosis of the patients with HICH according to the image data was (1-2 = 6.575, P = 0.037). Conclusion: After the operation of the craniotomy, the factors that affect the prognosis of the HICH are diverse and complex, and a reasonable conclusion can be drawn through the analysis of clinical data and data. Among the various factors, HICH was admitted to the high and low systolic blood pressure (SBP) of the patient, whether the pulmonary infection, the size of the pupil, the GCS coma score, the position of the hematoma, the presence or absence of the midline, the amount of the cerebral hemorrhage, the second bleeding after the operation, whether the bleeding is broken into the ventricle, The blood sugar level and other factors are of statistical significance. The age, sex, and timing of the operation of HICH are not the decisive factors that affect the prognosis. To this end, it is possible to benefit the HICH patients by giving appropriate treatment to the clinically relevant factors that can improve the prognosis of the HICH patients. Scientific and reasonable decision-making can help improve the prognosis of HICH patients, reduce the mortality and disability rate, and improve the survival rate and quality of life.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.12
本文編號：2491229
[Abstract]:Objective: To study the general clinical characteristics of hypertensive cerebral hemorrhage (HICH). The age, sex, systolic blood pressure (SBP), admission blood sugar, postoperative pulmonary infection, pre-operative pupil size, GCS coma score, bleeding position and midline shift of HICH were studied by statistical method. The effect of post-operative hypertensive cerebral hemorrhage on the prognosis of patients with hypertensive cerebral hemorrhage after operation, such as the amount of cerebral hemorrhage, the timing of operation, the bleeding of the hemorrhage into the ventricle, and the occurrence of secondary hemorrhage. Clinical intervention can be given to factors that can improve the prognosis of HICH patients. Scientific and reasonable decision-making is used to improve the prognosis of HICH patients. Methods:118 HICH patients admitted to the hospital during the neurosurgery of the first Affiliated Hospital of Anhui Medical College during the period of 2015.01-2016.10 were selected, and the preoperative imaging data, relevant clinical data and postoperative data were retrospectively analyzed, including the age of the patient, systolic blood pressure (SBP), Thirteen factors such as pulmonary infection, pupil size, blood glucose level, GCS coma score, hemorrhage site, midline shift, cerebral hemorrhage, operation timing, and whether secondary hemorrhage occurred after operation. According to the Glasgow Outcome Score (GOS), the patient's recovery in January was determined, and the post-operative condition of the patient could be quantified. Analysis method of statistical data: using the single factor analysis method: using the SPSS16.0 software for the selected data, and analyzing according to the chi-square test (1-2 test). Results: The recovery of 118 patients with hypertensive cerebral hemorrhage after 1 month after operation was determined according to the GOS score. Patients with a score of 3-5 were classified as good prognosis and good prognosis; patients with a score of 1-2 were classified as poor prognosis and poor prognosis. In which:1. The effect of GCS (2 = 18.514, P = 0.000) on the post-operative recovery of patients with hypertensive cerebral hemorrhage was affected (P = 18.514, P = 0.000). The effect of preoperative blood glucose level on the prognosis of HICH patients (1 ~ 2 = 7.212, P = 0.007); The effect of intracranial hemorrhage on the prognosis of HICH patients after operation (1 ~ 2 = 10.909, P = 0.004); The effect of pre-operative pupillary change on the prognosis of patients after operation (1-2 = 10.872, P = 0.001);5. The effect of preoperative systolic blood pressure on the prognosis of HICH patients (1 ~ 2 = 8.397, P = 0.004); Whether the median line is displaced is affected by the outcome of the surgical treatment (1-2 = 4.604, P = 0.032);7. The prognosis of patients with HICH after HICH was affected (1 ~ 2 = 6.363, P = 0.012).8. The effect of secondary hemorrhage on the prognosis of HCIH patients after operation (1 ~ 2 = 6.894, P = 0.009);9. The effect of postoperative pulmonary infection on the prognosis of HICH (1 ~ 2 = 10.273, P = 0.001);10. The choice of time of operation on the prognosis of the patients after craniotomy (1-2 = 5.158, P = 0.076);11. The effect of gender on the prognosis of patients after craniotomy (1-2 = 0.014, P = 0.905); The effect of age on the prognosis of HCIH patients after craniotomy (1-2 = 4.303, P = 0.116);13. The effect of pre-operative bleeding on the prognosis of the patients with HICH according to the image data was (1-2 = 6.575, P = 0.037). Conclusion: After the operation of the craniotomy, the factors that affect the prognosis of the HICH are diverse and complex, and a reasonable conclusion can be drawn through the analysis of clinical data and data. Among the various factors, HICH was admitted to the high and low systolic blood pressure (SBP) of the patient, whether the pulmonary infection, the size of the pupil, the GCS coma score, the position of the hematoma, the presence or absence of the midline, the amount of the cerebral hemorrhage, the second bleeding after the operation, whether the bleeding is broken into the ventricle, The blood sugar level and other factors are of statistical significance. The age, sex, and timing of the operation of HICH are not the decisive factors that affect the prognosis. To this end, it is possible to benefit the HICH patients by giving appropriate treatment to the clinically relevant factors that can improve the prognosis of the HICH patients. Scientific and reasonable decision-making can help improve the prognosis of HICH patients, reduce the mortality and disability rate, and improve the survival rate and quality of life.
【學(xué)位授予單位】：皖南醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R651.12
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