摘要
目的:了解出血性脑卒中(ICH)患者术后的近期预后,构建死亡风险方程,为救护措施的制定和预后评估提供指导。方法:纳入手术治疗的242例首发ICH患者,追踪术后30 d生存情况。结果:(1)本组ICH患者30 d生存率为78.0%。(2)死亡组与生存组在年龄、收缩压、血K+、NIHSS评分、GCS评分、出血部位、脑中线结构移位和发病到手术时间的暴露水平不同(P<0.05)。其中年龄(RR=1.949)、出血部位(RR=2.256)、NIHSS评分(RR=1.075)和发病到手术时间(RR=2.336,RR=2.895)是影响预后的独立因素。(3)死亡风险方程:h(t,X)/h0(t)=Exp[0.668年龄+0.841出血部位+0.072 NIHSS评分+0.849(发病到手术时间6～12 h)+1.063(发病到手术时间≥12 h)]。方程、NIHSS评分、发病到手术时间、出血部位、年龄预测死亡的ROC曲线下面积分别是0.835、0.692、0.662、0.642和0.614。结论:ICH术后具有高病死率,NIHSS评分、发病到手术时间、出血部位和年龄均可用于预后的评估,以多个指标综合评估预后的可靠性更佳。
Objectives To understand the early prognosis of patients with intracerebral hemorrhage（ICH） after surgical treatment,and to establish an equation of death risk which guide treatment and prognostic assessment.Methods We analyzed 242 patients with first-episode ICH after surgical treatment.All patients were followed up for 30 days.Results（1） The 30-day survival rate was 78.0%.（2） The death group and the survival group had significant differences in their age,systolic pressure,serum postassium level,NIHSS score,GCS score,hemorrhagic sites,brain midline structure dislocation,ICH onset and surgery delay time（P 0.05）.Among them,the age（RR = 1.949）,hemorrhagic sites（RR = 2.256）,NIHSS score（RR = 1.075）and ICH onset and surgery delay time（RR = 2.336,RR = 2.895）were independent prognostic factors for ICH patients.（3） The equation of death risk： h（t,X）/h0（t） = Exp[0.668 age＋0.841 hemorrhagic sites＋0.072 NIHSS score＋0.849（ICH onset and surgery delay time = 6 ～12 h）＋1.063（ICH onset and surgery delay time ≥ 12 h）].The areas under the ROC curve of equation,NIHSS score,ICH onset and surgery delay time,hemorrhagic sites and age-predicted death were 0.835,0.692,0.662,0.642 and 0.614,respectively.Conclusions ICH patients after surgical treatment have a high mortality.NIHSS score,ICH onset and surgery delay time,hemorrhagic sites and age can be used to assess prognosis of ICH patients.The reliability of comprehensive assessment using all the factors is better than that using one of these factors.
出处
《实用医学杂志》
CAS
北大核心
2012年第7期1091-1094,共4页
The Journal of Practical Medicine
关键词
卒中
外科治疗
预后
COX比例风险模型
Stroke
Surgical treatment
Prognosis
Cox proportional hazard model
