原发性脑桥出血的预后因素分析

目的探讨原发性脑桥出血患者的预后及影响因素。方法连续登记2009年1月至2013年3月云南省玉溪市人民医院收治的发病后24 h内入院的原发性脑桥出血患者83例,失访7例,完成随访76例,其中男性45例(59.2%),女性31例(40.8%)。随访患者,记录发病后1年的生存状态(生存组和死亡组)。应用Cox比例风险模型对影响患者1年生存率的因素进行分析。结果原发性脑桥出血患者76例中,死亡32例,总病死率为42.1%;1个月内死亡28例,1个月病死率为36.8%。存活组平均血肿体积(2.58±2.18)mL,死亡组平均血肿体积(11.02±8.33)mL,两组比较,t=5.625,P=0.000。不同部位的原发性脑桥出血患者1年病死率比较,被盖型(4/26例)与混合型(21/29例)比较(χ2=17.983,P=0.000)。存活组入院时格拉斯哥昏迷(GCS)评分(13.27±3.19)分,死亡组GCS评分(6.13±3.66)分,两组比较(t=9.055,P=0.000)。Cox比例风险模型显示,影响原发性脑桥出血患者1年死亡的主要因素有:血肿体积(RR=1.061,95%CI:1.013~1.111),入院时GCS评分(RR=0.825,95%CI:0.738~0.922)。结论 GCS评分和血肿体积是原发性脑桥出血预后的临床和影像学预测指标,GCS评分低、血肿体积大提示预后差。

Analysis of Prognosis in Patients with Primary Pontine Hemorrhage

Aim To evaluate prognosis and its clinical factors in patients with primary pontine hemorrhage. Methods Patients with primary pontine hemorrhage who were hospitalized in the people＇s hospital of Yuxi within 24 hours after stroke oneset from January 2009 to March 2013 were registered consecutively. The patients were followed up for one year. Cox proportional hazard model was used to study risk factors for survival rate in one year. Results A total of 76 patients with primary pontine hemorrhage were studied. There were 37 males and 22 females. One month mortality rate was 36.8%. One year mortality rate was 42.1%. The average hematoma volume of the survival group and the death group were（2.58±2.18） mL and（11.02±8.33） mL respectively, showing statistical significance（t= 5.625, P=0.000）. The mortality rate in the patients with primary dorsal pontine hemorrhage was significantly lower than that in the patients with massive primary pontine hemorrhage（χ^2=17.983, P=0.000）. Compared with the GCS scores when they enrolled between the survival group（13.27±3.19） and the death group（6.13±3.66）;there was a significantdifference（t=9.055, P=0.000）. Cox proportional hazards model showed that the risk factors associated with mortality were hematoma volume, GCS scores. Conclusion A significant correlation was observed between poor prognosis, GCS scores on admission, and hematoma volume.