本文選題：基底節(jié)區(qū)　切入點(diǎn)：高血壓腦出血　出處：《石河子大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:為了探討高血壓基底節(jié)區(qū)出血治療的臨床療效,綜合詳細(xì)分析影響其短期預(yù)后的相關(guān)因素,以達(dá)到提高患者的治愈率、降低致殘率。方法:此次臨床研究在通過結(jié)合國內(nèi)外相關(guān)文獻(xiàn)資料的研究結(jié)果以及豐富的臨床治療經(jīng)驗(yàn),進(jìn)行回顧分析新疆維吾爾自治區(qū)人民醫(yī)院神經(jīng)外科于2013年5月-2016年12月收治的176例符合納入及排除標(biāo)準(zhǔn)的腦出血患者。通過篩選決定采用以下變量的臨床資料為影響預(yù)后的因素:個(gè)人資料(年齡、性別),既往史(包括高血壓病史),術(shù)前一般情況(包括術(shù)前收縮壓、術(shù)前血糖值、術(shù)前GCS評(píng)分),術(shù)前CT表現(xiàn)(包括血腫體積、血腫形態(tài)、腦室積血、中線是否移位),手術(shù)時(shí)間,手術(shù)方式,術(shù)后發(fā)生的并發(fā)癥(包括術(shù)后再出血、肺部感染、上消化道出血);選用日常生活能力(ADL)評(píng)分作為判斷患者1個(gè)月后神經(jīng)功能恢復(fù)情況的標(biāo)準(zhǔn),按臨床預(yù)后情況分為兩組:1、預(yù)后良好組,其ADL評(píng)分為I、II、III級(jí);2、預(yù)后不良組,其ADL評(píng)分為IV、V級(jí)。采用c2檢驗(yàn)進(jìn)行單因素分析;然后將對(duì)預(yù)后有統(tǒng)計(jì)學(xué)意義的單因素引入多元邏輯回歸模型,綜合分析這些影響因素與預(yù)后的相關(guān)性。結(jié)果:(1)收集176例符合研究要求的患者進(jìn)行臨床研究。包括男性117例,女性59例,年齡范圍在30~80歲之間,平均(54.47±9.23)歲,既往高血壓病史范圍在1~31年之間,平均(6.95±5.76)年,術(shù)前收縮壓值范圍在128~224mmHg之間,平均(147.76±27.51)mmHg,術(shù)前血糖值范圍在4.2~22.2mmol/L之間,平均(8.02±3.53)mmol/L,術(shù)前GCS評(píng)分范圍在6~14分之間,平均(10.65±2.32)分,左側(cè)基底節(jié)區(qū)95例,右側(cè)基底節(jié)區(qū)81例,血腫體積范圍在24~65ml之間,平均(38.42±10.22)ml,血腫形態(tài)不規(guī)則77例,血腫破入腦室積血41例,中線移位45例,入院至手術(shù)時(shí)間范圍在8~72h之間,平均(21.46±8.35)h,行微創(chuàng)血腫穿刺引流術(shù)95例,行開顱血腫清除術(shù)81例,術(shù)后發(fā)生二次出血16例,術(shù)后發(fā)生肺部感染63例,術(shù)后發(fā)生上消化道出血9例,預(yù)后良好86例,預(yù)后不良90例。(2)單因素采用c2檢驗(yàn)分析結(jié)果:患者年齡、術(shù)前血糖值、術(shù)前GCS評(píng)分、血腫體積、血腫形態(tài)、入院至手術(shù)時(shí)間、血腫破入腦室積血、中線發(fā)生移位、術(shù)后再出血、術(shù)后肺部感染10個(gè)因素對(duì)患者的預(yù)后有明顯影響。(3)以P=0.05為檢驗(yàn)標(biāo)準(zhǔn),將有統(tǒng)計(jì)學(xué)意義的單因素納入多元邏輯回歸模型中,綜合分析得到結(jié)果顯示:患者年齡、術(shù)前血糖值、術(shù)前GCS評(píng)分、血腫體積、入院至手術(shù)時(shí)間與預(yù)后具有負(fù)相關(guān)性;血腫是否規(guī)則、血腫破入腦室是否積血、術(shù)后是否再出血、術(shù)后肺部是否感染與患者預(yù)后具有正相關(guān)性。結(jié)論:經(jīng)過統(tǒng)計(jì)學(xué)綜合分析高血壓基底節(jié)區(qū)出血患者的早期預(yù)后影響因素,可以得到以下結(jié)論:1、通過單因素采用c2檢驗(yàn)分析說明患者年齡、術(shù)前血糖值、術(shù)前GCS評(píng)分、血腫體積、血腫形態(tài)、入院至手術(shù)時(shí)間、血腫破入腦室積血、中線發(fā)生移位、術(shù)后再出血、術(shù)后肺部感染10個(gè)因素對(duì)患者的預(yù)后有明顯影響。2、通過多元邏輯回歸模型分析說明患者年齡、術(shù)前血糖值、術(shù)前GCS評(píng)分、血腫體積、血腫破入腦室積血、術(shù)后再出血、術(shù)后肺部感染是獨(dú)立關(guān)鍵影響因素。明確以上相關(guān)因素,在臨床上給予重視并加以干涉和治療,對(duì)患者神經(jīng)功能恢復(fù)產(chǎn)生積極的效果,達(dá)到改善患者預(yù)后的目的,對(duì)提高患者的治愈率、降低致殘率方面具有臨床指導(dǎo)意義。
[Abstract]:Objective: To investigate the clinical effect in the treatment of hypertensive basal ganglia hemorrhage, with comprehensive analysis of relevant factors influencing the short-term prognosis, in order to improve the cure rate of patients, reduce the disability rate. Methods: the clinical study in the combination of domestic and foreign literature research results and rich clinical experience, were retrospectively analyzed in Department of Neurosurgery the Xinjiang Uygur Autonomous Region people's Hospital in May 2013 -2016 year in December 176 cases met the inclusion and exclusion criteria of patients with cerebral hemorrhage. The clinical data by screening decision using the following variables as prognostic factors: personal information (age, gender), medical history (including hypertension), preoperative general condition (including preoperative systolic blood pressure. Preoperative blood glucose, preoperative GCS score), preoperative CT findings (including the volume of hematoma, hematoma, intraventricular hemorrhage, midline shift, the operation time is), Surgical methods, postoperative complications (including postoperative hemorrhage, pulmonary infection, upper gastrointestinal bleeding); the ability of daily life (ADL) score was used as the recovery of the neurological function of patients after 1 months of standard, according to the clinical prognosis were divided into two groups: 1 patients with good prognosis, the ADL score I, II, III; 2, the poor prognosis group, the ADL score is IV, V. C2 test was used for univariate analysis; single factor and statistical significance on the prognosis of the multivariate logistic regression model was introduced, a comprehensive analysis of these factors and the correlation between the prognosis. Results: (1) 176 patients met the study requirements of patients with clinical research. Including male 117 cases, female 59 cases, age between 30~80 years old, the average (54.47 + 9.23) years old, had a history of hypertension in the range of 1~31 years, the average (6.95 + 5.76) years, preoperative systolic blood pressure values in the range of 128~224mmHg, the average (14 7.76鹵27.51)mmHg,鏈墠琛，

本文編號(hào)：1607629