自发性脑出血患者入院30 d内死亡的危险因素分析

摘要

目的 探讨自发性脑出血患者入院30 d内死亡的危险因素.方法 选择2011年1月-2016年1月内蒙古医科大学附属医院收治的自发性脑出血342例,根据患者入院30 d内是否死亡将其分为病死组(86例)和存活组(256例)两组.观察比较两组主要临床特征,采用受试者工作特征(ROC)曲线下面积分析年龄、格拉斯哥昏迷评分(GCS)和出血量预测自发性脑出血患者入院30 d内死亡的临床价值,采用单因素和多因素Logistic回归分析分析自发性脑出血患者入院30 d内死亡的危险因素.结果 与存活组比较,病死组GCS较低,出血量较大,基底节出血发生率较低,小脑出血发生率及合并脑室出血发生率较高,手术治疗率较低,两组比较差异均有统计学意义 (P<0.05).经分析ROC曲线下面积发现GCS和出血量预测自发性脑出血患者入院30 d内死亡具有一定临床价值(均P<0.001).单因素和多因素Logistic回归分析显示GCS、出血量和小脑出血是自发性脑出血患者入院30 d内死亡的独立危险因素.结论 GCS、出血量和小脑出血是自发性脑出血患者入院30 d内死亡的独立危险因素.%Objective To investigate risk factors of death within 30 days after admission in patients with spontaneous intracerebral hemorrhage.Methods A total of 342 patients with spontaneous intracerebral hemorrhage admitted during January 2011 and January 2016 were divided into death group (n=86) and survival group (n=256) according to whether or not death within 30 days after admission.Mainly clinical characteristics were observed in two groups.The age was analyzed using the area under the receiver operating characteristics (ROC) curve, and Glasgow coma scale (GCS) score and bleeding volume within 30 days after admission in patients with spontaneous intracerebral hemorrhage were used to predict death,and the risk factors of death within 30 days after admission in patients with spontaneous intracerebral hemorrhage were analyzed using single factor and multiple factors logistic regression analysis.Results Compared with those in survival group, in death group, GCS score was significantly lower;bleeding volume was significantly more;incidence rate of basal ganglia hemorrhage was significantly lower;incidence rates of cerebellar hemorrhage and combination of intraventricular hemorrhage were significantly higher;therapy rate of surgery was lower ((P<0.05).Analysis of the area under the ROC curve showed that GCS and the bleeding volume had a certain clinical value in prediction of death within 30 days after admission in patients with spontaneous intracerebral hemorrhage (P<0.001).Single factor and multiple factors logistic regression analysis showed that CGS, bleeding volume and cerebellar hemorrhage were the independent risk factors of death within 30 days after admission in patients with spontaneous intracerebral hemorrhage.Conclusion GSC, the bleeding volume and cerebellar hemorrhage are the independent risk factors of death within 30 days after admission in patients with spontaneous intracerebral hemorrhage.