作者：贾磊华，李国珍，吕志坤，赵传清，刘强

单位：

1.072750河北省保定市第二中心医院神经内科 2.072750河北省保定市第二中心医院神经外科 通信作者：贾磊华，E-mail：moonlightjia2020@163.com

Units：

1.Department of Neurology, Baoding Second Central Hospital, Baoding 072750, China 2.Department of Neurosurgery, Baoding Second Central Hospital, Baoding 072750, China Corresponding author: JIA Leihua, E-mail: moonlightjia2020@163.com

关键词：

脑出血; 神经功能缺损程度; 影响因素分析;

Keywords：

Cerebral hemorrhage; Degree of neurological deficit; Root cause analysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.140

Funds：

摘要：

目的 分析脑出血(ICH)患者术后神经功能缺损程度的影响因素。方法 选取2017年3月至2021年8月保定市第二中心医院收治的184例ICH患者,所有患者行微创穿刺清除术或小骨窗开颅手术。于术后3个月采用改良爱丁堡-斯堪的纳维亚卒中量表(MESSS)评估患者神经功能缺损程度,将术后3个月MESSS评分≤15分患者纳入轻度组,>15分患者纳入中重度组。比较两组一般资料(性别、年龄)、病情信息[入院时格拉斯哥昏迷量表(GCS)评分、入院时神经功能缺损程度、出血部位、出血量、出血是否破入脑室]、治疗情况(手术时机、手术方式、有无二次手术、术后并发症发生情况、术后是否接受早期康复治疗)、生化指标[入院时白细胞计数、血糖、血清超敏C反应蛋白(hs-CRP)];采用多因素Logistic回归分析探讨ICH患者术后神经功能缺损程度的影响因素。结果 术后3个月184例患者中,轻度神经功能缺损103例(56.0%),中重度神经功能缺损81例(44.0%)。多因素Logistic回归分析结果显示,入院时GCS评分[9～11分:OR=2.061,95%CI(1.131,3.754);≤8分:OR=2.312,95%CI(1.312,4.074)]、入院时神经功能缺损程度[OR=2.427,95%CI(1.492,3.946)]、出血量[OR=2.317,95%CI(1.341,4.003)]、出血破入脑室[OR=1.860,95%CI(1.031,3.355)]、手术时机[早期:OR=1.879,95%CI(1.007,3.504);延期:OR=2.029,95%CI(1.147,3.589)]、术后并发脑梗死[OR=1.941,95%CI(1.087,3.467)]、术后接受早期康复治疗[OR=1.961,95%CI(1.074,3.579)]、入院时白细胞计数[OR=2.160,95%CI(1.209,3.858)]、入院时血清hs-CRP[OR=2.097,95%CI(1.160,3.790)]为ICH患者术后神经功能缺损程度的影响因素(P<0.05)。结论 ICH患者术后神经功能缺损程度的影响因素包括入院时GCS评分、入院时神经功能缺损程度、出血量、出血破入脑室、手术时机、术后并发脑梗死、术后接受早期康复治疗、入院时白细胞计数、入院时血清hs-CRP,故应针对上述一些可控因素进行干预,以促进患者神经功能的恢复。

Abstract：

【Abstract】 Objective To analyse the influencing factors of degree of neurological deficit in intracerebral hemorrhage(ICH) patients after surgery. Methods A total of 184 ICH patients admitted to Baoding Second Central Hospital from March2017 to August 2021 were selected, and all patients underwent minimally invasive puncture debridement or small bone windowcraniotomy. Modified Edinburgh Scandinavian Stroke Scale (MESSS) was used to evaluate the degree of neurological deficit ofpatients at 3 months after surgery. Patients with MESSS score ≤ 15 at 3 months after operation were included in the mild group,and those with a score > 15 were included in the moderate-severe group. General condition (sex, age) , condition information[Glasgow Coma Scale (GCS) score at admission, degree of neurological deficit at admission, location of bleeding, amount ofbleeding, whether the bleeding broke into the ventricle] , treatment status (timing of operation, method of operation, whether therewas a second operation, whether there were postoperative complications, whether receiving early rehabilitation after surgery) ,biochemical indicators [white blood cell count, blood glucose, serum hypersensitivity C-reactive protein (hs-CRP) at admission]were compared between the two groups. Multivariate Logistic regression analysis was used to explore the influencing factors of thedegree of neurological deficit in ICH patients after surgery. Results Three months after the operation, 103 cases (56.0%) of the184 patients had mild neurological deficit, and 81 (44.0%) had moderate to severe neurological deficit. The results of multivariateLogistic regression analysis showed that GCS score at admission [9-11 scores: OR=2.061, 95%CI (1.131, 3.754) ; ≤ 8 scores:OR=2.312, 95%CI (1.312, 4.074) ] , degree of neurological deficit at admission [OR=2.427 , 95%CI (1.492, 3.946) ] , amount ofbleeding [OR=2.317, 95%CI (1.341, 4.003) ] , bleeding broke into the ventricle [OR=1.860, 95%CI (1.031, 3.355) ] , timing ofoperation [early: OR=1.879, 95%CI (1.007, 3.504) ; late: OR=2.029, 95%CI (1.147, 3.589) ] , postoperative cerebral infarction[OR=1.941, 95%CI (1.087, 3.467) ] , receiving early rehabilitation after surgery [OR=1.961, 95%CI (1.074, 3.579) ] , white bloodcell count at admission [OR=2.160, 95%CI (1.209, 3.858) ] , serum hs-CRP at admission [OR=2.097, 95%CI (1.160, 3.790) ] wereinfluencing factors of degree of neurological deficit in ICH patients after surgery (P ＜ 0.05) . Conclusion The influencing factorsof degree of neurological deficit in ICH patients after surgery included GCS score at admission, degree of neurological deficit atadmission, amount of bleeding, bleeding broke into the ventricle, timing of operation, postoperative cerebral infarction, receivingearly rehabilitation after surgery, white blood cell count at admission, serum hs-CRP at admission. Therefore, interventions shouldbe made for some of the above controllable factors to promote the recovery of neurological function of patients.

ReferenceList：