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中华脑科疾病与康复杂志(电子版)

中华脑科疾病与康复杂志(电子版) ›› 2024, Vol. 14 ›› Issue (04) : 213 -217. doi: 10.3877/cma.j.issn.2095-123X.2024.04.004

临床研究

原发性脑干出血30天死亡的危险因素分析
柏明涛1, 黄宝辰1, 牛纪杰1, 张玉海1, 穆振欣1,†()   
  1. 1.100039 山东日照，日照市人民医院神经外科
  • 收稿日期:2024-01-13 出版日期:2024-08-15
  • 通信作者: 穆振欣

Analysis of risk factors for 30-day mortality in primary brainstem hemorrhage

Mingtao Bai1, Baochen Huang1, Jijie Niu1, Yuhai Zhang1, Zhenxin Mu1,†()   

  1. 1.Department of Neurosurgery, Rizhao People’s Hospital, Rizhao 100039, China
  • Received:2024-01-13 Published:2024-08-15
  • Corresponding author: Zhenxin Mu
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柏明涛, 黄宝辰, 牛纪杰, 张玉海, 穆振欣. 原发性脑干出血30天死亡的危险因素分析[J]. 中华脑科疾病与康复杂志(电子版), 2024, 14(04): 213-217.

Mingtao Bai, Baochen Huang, Jijie Niu, Yuhai Zhang, Zhenxin Mu. Analysis of risk factors for 30-day mortality in primary brainstem hemorrhage[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2024, 14(04): 213-217.

目的

分析原发性脑干出血（PBSH）患者30 d 死亡的相关危险因素。

方法

回顾性分析山东省日照市人民医院神经外科自2019年6月至2023年12月收治的101例PBSH患者的临床资料，包括患者性别、年龄、既往病史、血糖、体质量指数（BMI）、入院时GCS评分、血肿体积、手术治疗、CT 最大层面血肿横断位最长径、脑室出血等。根据患者院内和(或)出院30 d 期间死亡与否，将患者分为生存组和死亡组。采用Kaplan-Meier 法及Cox 回归法分析PBSH 患者30 d 死亡的危险因素。

结果

101 例患者中生存组66 例（65.4%），死亡组35 例（34.6%）。2 组患者中入院GCS 评分＜8分、血肿总体积量≥5 mL、合并脑室出血、CT 最大血肿层面横断位最长径≥2.6 cm 占比比较，差异均有统计学意义（P＜0.05）。多因素Cox 回归分析结果显示，CT 最大血肿层面横断位最长径≥2.6 cm（HR=3.37，95%CI：1.10～10.37，P=0.034）及入院GCS 评分＜8 分（HR=20.18，95%CI：2.53～160.80，P=0.005）是影响PBSH 患者30 d 死亡的独立危险因素。

结论

入院时GCS 评分较低及CT最大血肿层面横断位最长径较长的PBSH患者的30 d死亡率显著增加，对预后评估起重要作用。

关键词: 原发性脑干出血, 危险因素, 预后

Objective

To analyze the risk factors associated with 30-day mortality in patients with primary brainstem hemorrhage (PBSH).

Methods

A retrospective analysis was performed on the clinical data of 101 patients with PBSH who were admitted to the Neurosurgery Department of Rizhao People’s Hospital from June 2019 to December 2023, including gender, age, medical history, blood glucose levels, body mass index (BMI), GCS score at admission, volume of blood clot, surgical interventions undertaken,maximum transverse diameter of the blood clot on CT imaging,and instances of intracranial hemorrhage.According to whether the patients died within hospitalization and 30-day after discharge, all patients were divided into survival group and death group.The risk factors associated with 30-day mortality were evaluated using Kaplan-Meier survival curves and Cox regression analysis.

Results

Among the 101 patients, 66 (65.4%) were in the survival group and 35 (34.6%) were in the death group.The proportion of patients with admission GCS score＜8 scores, total hematoma volume≥5 mL, concomitant intraventricular hemorrhage, and the longest diameter of haematoma transected at the level of the largest CT dimension≥2.6 cm between the two groups showed statistically significant differences (P＜0.05).Cox’s multifactorial regression analysis showed that the longest diameter of haematoma transected at the level of the largest CT dimension≥2.6 cm(HR=3.37,95%CI:1.10-10.37,P=0.034), and GCS score ＜8 scores (HR=20.18, 95%CI: 2.53-160.80, P=0.005) were independent risk factors affecting the 30-day mortality of patients with PBSH.

Conclusion

The 30-day mortality rate was significantly higher in PBSH patients with lower GCS scores at admission and a longer maximal transverse diameter at the largest hematoma level on CT.The critical role of these two indicators in prognostic evaluation should be emphasized in clinical practice.

Key words: Primary brainstem hemorrhage, Risk factor, Prognosis
表1 2组PBSH患者的临床资料比较
Tab.1 Comparison of clinical data between two groups of PBSH patients
项目 生存组（n=66） 死亡组（n=35） χ 2 /t值 P值
年龄（岁，Mean±SD） 55.2±12.7 50.7±12.5 3.036 0.273
女性[例（%）] 19（28.8） 10（28.6） 0.001 0.654
入院GCS评分＜8分[例（%）] 26（39.4） 34（97.1） 31.629 0.001
高血压病史[例（%）] 59（89.4） 33（94.3） 0.566
糖尿病病史[例（%）] 8（12.1） 4（11.4） 0.692
抗板药物服用史[例（%）] 7（10.6） 4（11.4） 0.905
入院收缩压≥160mmHg[例（%）] 55（83.3） 29（82.9） 0.004 0.776
入院血糖≥8.3mmol/L[例（%）] 20（30.3） 13（37.1） 0.486 0.672
BMI[例（%）] 0.367 0.189
＜24kg/m2 17（25.8） 22（34.3）
≥24kg/m2 49（74.2） 23（65.7）
治疗方式[例（%）] 0.375
手术治疗 5（7.6） 7（20.0）
内科保守治疗 61（92.4） 28（80.0）
合并脑室出血[例（%）] 13（19.7） 14（40.0） 4.813 0.021
CT最大血肿层面横断位最长径≥2.6cm[例（%）] 23（34.8） 31（88.6） 26.531 ＜0.001
血肿体积≥5mL[例（%）] 21（31.8） 21（60.0） 7.478 0.014
表2 影响PBSH患者30 d天死亡的多因素Cox回归分析
Tab.2 Multifactorial Cox regression analysis of influencing 30-d mortality in PBSH patients
因素 偏回归系数 标准误 Waldχ2值 P值 HR值 95%CI
CT最大血肿层面横断位最长径≥2.6cm 1.215 0.573 2.120 0.034 3.37 1.10～10.37
手术治疗 -0.781 0.534 -1.461 0.144 0.46 0.16～1.31
合并脑室出血 0.587 0.420 1.398 0.162 1.80 0.79～4.09
入院GCS评分＜8分 3.005 1.059 2.838 0.005 20.18 2.53～160.80
血肿体积≥5mL 0.214 0.415 0.517 0.605 1.24 0.55～2.79
入院血糖≥8.3mmol/L -0.747 0.396 -1.888 0.059 0.47 0.22～1.03
BMI≥24kg/m2 -0.298 0.390 -0.764 0.445 0.74 0.35～1.59
图1 不同临床特征PBSH患者术后Kaplan-Meier生存曲线的比较 A：不同血肿横断位最长直径PBSH患者（P＜0.001）；B：不同血肿体积PBSH患者（P=0.014）；C：是否合并脑室出血PBSH患者（P=0.018）；D：不同GCS评分PBSH患者（P＜0.001）；PBSH：原发性脑干出血
Fig.1 Comparison of Kaplan-Meier survival curves for postoperative patients with PBSH based on different clinical characteristics
[1]
中华医学会神经外科学分会脑血管病学组,中国医师协会神经外科医师分会脑血管外科学组.原发性脑干出血诊治中国神经外科专家共识[J].中华医学杂志, 2022, 102(15): 1068-1075.DOI:10.3760/cma.j.cn112137-20211228-02913.Cerebrovascular Disease Group of the Neurosurgery Branch of the Chinese Medical Association, Cerebrovascular Surgery Group of the Neurosurgeons Branch of the Chinese Medical Association.Chinese neurosurgical expert consensus on the diagnosis and treatment of primary brainstem haemorrhage[J].Natl Med J China,2022,102(15):1068-1075.DOI:10.3760/cma.j.cn112137-20211228-02913.
[2]
Wang SS, Yang Y, Velz J, et al.Management of brainstem haemorrhages[J].Swiss Med Wkly, 2019, 149: w20062.DOI: 10.4414/smw.2019.20062.
[3]
彭佳华, 龙少好, 黄兰青, 等.自发性脑出血患者血肿形态分析对早期血肿扩大的预测与诊断价值[J].中华急诊医学杂志, 2020, 29(4): 565-572.DOI: 10.3760/cma.j.issn.1671-0282.2020022.012-1.Peng JH, Long SH, Huang LQ, et al.Hematoma morphology analysis on predicting and diagnosis hematoma expansion in patients with spontaneous intracerebral hemorrhage[J].Chin J Emerg Med,2020,29(4):565-572.DOI:10.3760/cma.j.issn.1671-0282.2020022.012-1.
[4]
中华医学会神经外科学分会,中国医师协会急诊医师分会,中华医学会神经病学分会脑血管病学组,等.高血压性脑出血中国多学科诊治指南[J].中华神经外科杂志, 2020, 36(8): 757-770.DOI:10.3760/cma.j.cn112050-20200510-00282.Neurosurgery Branch of Chinese Medical Association, Emergency PhysiciansBranchofChineseMedicalAssociation,Cerebrovascular Disease Group of Neurology Branch of Chinese Medical Association, et al.Chinese multidisciplinary diagnosis and treatment guidelines for hypertensive cerebral haemorrhage[J].Chin J Neurosurg, 2020, 36(8): 757-770.DOI: 10.3760/cma.j.cn112050-20200510-00282.
[5]
高武云,马万明,张亚军,等.老年原发性脑干出血后死亡的危险因素分析[J].中国实用医刊, 2020, 47(2): 61-64.DOI:10.3760/cma.j.issn.1674-4756.2020.02.018.Gao WY, Ma WM, Zhang YJ, et al.Analysis of risk factors of death after primary brainstem hemorrhage in the elderly[J].Chin J Pract Med, 2020, 47(2): 61-64.DOI: 10.3760/cma.j.issn.1674-4756.2020.02.018.
[6]
罗飞,张明升,黄巍,等.体质量指数与原发性脑干出血患者的临床特征、影像学特征和预后的关系[J].中国医师进修杂志,2022,45(1):37-42.DOI:10.3760/cma.j.cn115455-20201022-01426.Luo F, Zhang MS, Huang W, et al.Relationship between body mass index and clinical characteristics, imaging characteristics and prognosis of patients with primary brainstem hemorrhage[J].Chin J Postgrad Med, 2022, 45(1): 37-42.DOI: 10.3760/cma.j.cn115455-20201022-01426.
[7]
葛红飞,张超,尹怡,等.原发性脑干出血患者死亡的独立危险因素分析[J].中华神经外科杂志, 2019, 35(6): 588-591.DOI:10.3760/cma.j.issn.1001-2346.2019.06.010.Ge HF, Zhang C, Yin Y, et al.Analysis of independent risk factors in deaths of patients with primary brainstem hemorrhage[J].Chin J Neurosurg, 2019, 35(6): 588-591.DOI: 10.3760/cma.j.issn.1001-2346.2019.06.010.
[8]
Murata Y,Yamaguchi S,Kajikawa H,et al.Relationship between the clinical manifestations, computed tomographic findings and the outcome in 80 patients with primary pontine hemorrhage[J].J Neurol Sci,1999,167(2):107-111.DOI:10.1016/s0022-510x(99)00150-1.
[9]
刘凤强,王泽锋,俞晓波,等.立体定向精准抽吸治疗原发性脑干出血的疗效及其影响因素分析[J].中华神经外科杂志,2019,35(11):1094-1098.DOI:10.3760/cma.j.issn.1001-2346.2019.11.004.Liu FQ, Wang ZF, Yu XB, et al.Efficiency and influence factors of stereotactic precision aspiration in the treatment of primary brain stem hemorrhage[J].Chin J Neurosurg, 2019, 35(11): 1094-1098.DOI:10.3760/cma.j.issn.1001-2346.2019.11.004.
[10]
Behrouz R.Prognostic factors in pontine haemorrhage: a systematic review[J].Eur Stroke J, 2018, 3(2): 101-109.DOI:10.1177/2396987317752729.
[11]
游潮,陶传元.原发性脑干出血诊断与治疗历史、现状与未来[J].中国现代神经疾病杂志,2021,21(2):71-75.DOI:10.3969/j.issn.1672-6731.2021.02.002.You C, Tao CY.History, present and future of diagnosis and treatment of primary brainstem hemorrhage[J].Chin J Contemp Neurol Neurosurg, 2021, 21(2): 71-75.DOI: 10.3969/j.issn.1672-6731.2021.02.002.
[12]
Huang K, Ji Z, Sun L, et al.Development and validation of a grading scale for primary pontine hemorrhage[J].Stroke, 2017, 48(1):63-69.DOI:10.1161/strokeaha.116.015326.
[13]
Behrouz R.Prognostic factors in pontine haemorrhage: a systematic review[J].Eur Stroke J, 2018, 3(2): 101-109.DOI:10.1177/2396987317752729.
[14]
Yu Z,Zhang X,Xu Q,et al.Effect of hematoma volume on the 30-day mortality rate of patients with primary hypertensive brainstem hemorrhage: a retrospective cohort study[J].Front Surg, 2023, 10:1136296.DOI:10.3389/fsurg.2023.1136296.
[15]
万星延,孙晓川,程崇杰,等.CT 平扫征象与脑干出血患者预后相关性分析:双中心回顾性研究[J].现代医药卫生,2022,38(18):3072-3077.DOI:10.3969/j.issn.1009-5519.2022.18.003.Wan XY, Sun XC, Cheng CJ, et al.Correlation analysis of CT scan signs and prognosis of patients with brainstem hemorrhage:a two-center retrospective study[J].Journal of Modern Medicine &Health, 2022, 38(18): 3072-3077.DOI: 10.3969/j.issn.1009-5519.2022.18.003.
[16]
刘国芳,孙娟,陈珍珍,等.CT 征象预测原发性脑干出血患者意识障碍程度的价值[J].第三军医大学学报, 2021, 43(15):1437-1443.DOI:10.16016/j.1000-5404.202102093.Liu GF, Sun J, Chen ZZ, et al.Predictive value of CT signs for disorders of consciousness in patients with primary brainstem hemorrhage[J].Acta Acad Med Mil Tert, 2021, 43(15): 1437-1443.DOI:10.16016/j.1000-5404.202102093.
[17]
Nishizaki T, Ikeda N, Nakano S, et al.Factors determining the outcome of pontine hemorrhage in the absence of surgical intervention[J].Open J Modern Neurosurg, 2012, 2(2): 17-20.DOI:10.4236/ojmn.2012.22004.
[18]
Lan Z, Richard SA, Hao L, et al.Spontaneous hypertensive brainstem hemorrhage: does surgery benefit the severe cases?[J].Interdiscip Neurosurg, 2019, 15: 66-70.DOI: 10.1016/j.inat.2018.10.015.
[19]
Hemphill JC 3rd, Greenberg SM, Anderson CS, et al.Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J].Stroke, 2015, 46(7):2032-2060.DOI:10.1161/str.0000000000000069.
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