易扩张血肿与立体定向穿刺高血压脑出血患者不良预后的相关性研究

Association of easily dilated hematoma with poor prognosis in patients with hypertensive intracerebral hemorrhage after stereotactic puncture

摘要:

目的 探讨易扩张血肿与不易扩张血肿的高血压脑出血患者行立体定向穿刺术后的预后差异。方法 纳入2019年1月—2022年12月在重庆医科大学附属第一医院神经外科接受立体定向穿刺术治疗的127例高血压脑出血患者。基于头颅扫描分析的CT征象，并将患者分为易扩张血肿组和不易扩张血肿组。比较两组的年龄、性别、吸烟饮酒史、格拉斯哥昏迷量表（GCS）评分、血肿量、血肿部位、手术时机、术前血肿扩大、术后再出血和改良Rankin量表（mRS）评分。结果 与不易扩张血肿患者相比，易扩张血肿患者的不良预后率（mRS评分 3～6分占比）更高（65.9%比39.5%），差异有统计学意义（P＜0.05）；Logistic回归分析显示，易扩张血肿是立体定向穿刺术治疗患者不良预后的危险因素。结论 易扩张血肿患者在立体定向穿刺术后不良预后的风险高于不易扩张血肿的患者。

Abstract:

Objective To investigate the difference in prognosis after stereotactic puncture between hypertensive intracerebral hemorrhage patients with easily dilated hematoma and those without easily dilated hematoma.Methods A total of 127 patients with hypertensive intracerebral hemorrhage who underwent stereotactic puncture in Department of Neurosurgery， The First Affiliated Hospital of Chongqing Medical University， from January 2019 to December 2022 were enrolled， and according to the CT signs of cranial scan， the patients were divided into easily dilated hematoma group and non-easily dilated hematoma group. The two groups were compared in terms of age， sex， smoking and drinking history， Glasgow Coma Scale score， hematoma volume， hematoma location， operation timing， preoperative hematoma enlargement， postoperative re-bleeding， and modified Rankin Scale （mRS） score.Results The easily dilated hematoma group had a significantly higher rate of poor prognosis （mRS score： 3-6 points） than the non-easily dilated hematoma group （65.9% vs 39.5%， P <0.05）. The logistic regression analysis showed that easily dilated hematoma was an independent risk factor for poor prognosis in patients after stereotactic puncture （P <0.05）.Conclusions Patients with easily dilated hematoma tend to have a higher risk of poor prognosis after stereotactic puncture than those with non-easily dilated hematoma.