高血压脑出血患者立体定向手术治疗预后的影响因素分析

摘要

Objective To investigate the clinical effect of stereotactic surgery for hypertensive intracerebral hemorrhage and the factors affecting prognosis of the disease .Methods We retrospectively analyzed 90 cases of hypertensive cerebral hem‐orrhage patients in our hospital from January 2012 to January 2014 .The patients were divided into traditional and conservative treatment group (44 cases) and stereotactic surgery group (43 cases) according to the different treatments .Bleeding ,clinical efficacy and activities of daily living (ADL) scores ,cellular changes in immunological parameters were compared between two groups ,and prognostic factors in both groups were analyzed .Results Bleeding were significantly reduced in both conventional therapy group and the stereotactic group at 7 and 30 days after treatment (P<0.05) ,the amount of bleeding in stereotactic treatment group were only 53 .33 and 25 .19 percent of traditional group in each time ,which were significantly lower than the conventional group (P<0.05) .Total effective rate of traditional group (45.45 ,20/44) was significantly lower than that of stereotactic group (77.27% ,34/43). Self‐care ability improved extent were also superior in stereotactic group than in tradi‐tional group (P<0.05). Logistic regression analysis showed that the duration of hypertension (β=0.736 , P=0.037) ,GCS score (β=0.829 ,P=0.023) and BMI (β=2.19 ,P=0.017) were independent risk factors in traditional group;but independ‐ent risk factors were GCS score (β=0.799 , P= 0.010) and duration of hypertension (β=0.616 , P= 0.004) in stereotactic group. Conclusion Compared to conventional conservative treatment ,surgery can significantly improve the orientation of clini‐cal symptoms in patients with hypertensive cerebral hemorrhage ,and promote the prognosis of the disease.%目的：探讨立体定向手术治疗高血压脑出血的效果及影响预后的因素。方法87例高血压脑出血患者根据治疗方式分为传统保守治疗组（44例）和立体定向手术治疗组（43例）。分别比较治疗后2组患者出血量变化、临床疗效及日常生活活动（activity of daily living scale ，ADL ）量表评分的改变，分析2组预后的影响因素。结果2组患者治疗后7 d、30 d出血量均明显减少（P＜0.05），立体定向组在治疗后7 d、30 d的出血量均显著低于传统组（P＜0.05）。传统组总有效率（45.45％，20／44）明显低于立体定向组（77.27％，34／43），生活自理能力改善程度优于传统组（P＜0.05）。Logistic回归分析结果显示，高血压病程（β＝0.736，P＝0.037）、GCS评分（β＝0.829，P＝0.023）和体重指数（β＝2.19，P＝0.017）为传统组的独立高危影响因素；而GCS评分（β＝0.799，P＝0.010）和高血压病程（β＝0.616，P＝0.004）为立体定向组的独立高危因素。结论相比传统保守治疗，立体定向手术治疗可明显改善高血压脑出血患者的临床症状，促进疾病的预后。