作者：韩超，王如海，于强，胡海成，黄好峰，李习珍

单位：

阜阳师范大学附属第二医院神经外科

Units：

Department of Neurosurgery, the Second Affiliated Hospital of Fuyang Normal University, Fuyang 236000, China

关键词：

脑出血; 脑室出血; 格拉斯哥预后量表; 预后; 影响因素分析;

Keywords：

　Cerebral hemorrhage; Intraventricular hemorrhage; Glasgow Outcome Scale; Prognosis; Root causeanalysis

CLC：

DOI：

10.12114/j.issn.1008-5971.2023.00.087

Funds：

安徽省科技重大专项项目（201903a07020006）；

摘要：

目的 探讨重型脑室出血（SIVH）患者出院结局的影响因素。方法 回顾性选取2018年1月至2022年7月于阜阳师范大学附属第二医院神经外科行脑室外引流术（EVD）或神经内镜（NE）联合EVD治疗的SIVH患者101例为研究对象。收集患者的临床资料，根据出院时格拉斯哥预后量表（GOS）评分将患者出院结局分为结局不良及结局良好。采用多因素Logistic回归分析探讨SIVH患者出院结局的影响因素，采用ROC曲线分析年龄、术前格拉斯哥昏迷量表（GCS）评分、术前改良Graeb量表（mGS）评分及三者联合对SIVH患者出院结局不良的预测价值。结果101例SIVH患者中，结局良好39例（结局良好组），结局不良62例（结局不良组）。两组年龄、合并高血压者占比、术前血糖、术前血钾、术前血糖与血钾比值、术前GCS评分、术前mGS评分、合并脑疝者占比、手术方式比较，差异有统计学意义（P<0.05）。多因素Logistic回归分析结果显示，年龄[OR=0.877,95%CI(0.809,0.951)]、术前GCS评分[OR=1.754,95%CI(1.128,2.727)]、术前mGS评分[OR=0.747,95%CI(0.603,0.926)]是SIVH患者出院结局的影响因素（P<0.05）。ROC曲线分析结果显示，年龄预测SIVH患者出院结局不良的AUC为0.743[95%CI(0.647,0.825)]，术前GCS评分预测SIVH患者出院结局不良的AUC为0.825[95%CI(0.736,0.893)]，术前mGS评分预测SIVH患者出院结局不良的AUC为0.748[95%CI(0.625,0.890)]，三者联合预测SIVH患者出院结局不良的AUC为0.924[95%CI(0.854,0.967)]。结论 年龄、术前GCS评分、术前mGS评分是SIVH患者出院结局的影响因素，且三者联合对SIVH患者出院结局不良有较好的预测价值。

Abstract：

　Objective To investigate the influencing factors of discharge outcome of patients with severeintraventricular hemorrhage (SIVH) . Methods A total of 101 patients with SIVH who were treated with external ventriculardrainage (EVD) or neuroendoscopv (NE) combined with EVD in Department of Neurosurgery of the Second Affiliated Hospital ofFuyang Normal University from January 2018 to July 2022 were retrospectively selected as the research subjects. The general dataof the patients were collected. The discharge outcome of patients were divided into bad outcome and good outcome according tothe Glasgow Outcome Scale (GOS) score at discharge. Multivariate Logistic regression analysis was used to explore the influencingfactors of discharge outcome of patients with SIVH. ROC curve was used to analyze the value of age, preoperative Glasgow ComaScale (GCS) score, preoperative modified Graeb Scale (mGS) score and their combination in predicting discharge bad outcome inpatients with SIVH. Results Among 101 patients with SIVH, there were 39 cases with good outcome (the good outcome group)and 62 cases with bad outcome (the bad outcome group) . There was statistically significant differences in age, preoperative GCSscore, preoperative mGS score, proportion of cerebral hernia, surgical method between the two groups (P < 0.05) . MultivariateLogistic regression analysis showed that age [OR=0.877, 95%CI (0.809, 0.951) ] , preoperative GCS score [OR=1.754, 95%CI(1.128, 2.727) ] , preoperative mGS score [OR=0.747, 95%CI (0.603, 0.926) ] were influencing factors of discharge outcome ofpatients with SIVH (P < 0.05) . ROC curve analysis showed that the AUC of age in predicting discharge bad outcome in patientswith SIVH was 0.743 [95%CI (0.647, 0.825) ] , the AUC of preoperative GCS score in predicting discharge bad outcome inpatients with SIVH was 0.825 [95%CI (0.736, 0.893) ] , the AUC of preoperative mGS score in predicting discharge bad outcomein patients with SIVH was 0.748 [95%CI (0.625, 0.890) ] , and the AUC of their combination in predicting discharge bad outcome in patients with SIVH was 0.924 [95%CI (0.854, 0.967) ] . Conclusion Age, preoperative GCS score, preoperative mGS scoreare influencing factors of discharge outcome of patients with SIVH and their combination has good predictive value for dischargebad outcome of patients with SIVH.

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