老年脑出血后患者昏迷苏醒时间的多因素分析

目的 探讨影响老年脑出血后患者昏迷苏醒时间的相关因素。方法 选取本院2012年6月～2015年10月收治的82例老年脑出血昏迷患者为研究对象,以性别、年龄、术前格拉斯哥昏迷评分(GCS, Glasgow Coma Scale)、脑血肿量、血肿是否破入脑室、高血压病史、是否气管切开、治疗、并发感染等为自变量,昏迷至苏醒的时间为因变量,先进行单因素分析,对有统计学意义的变量采用Cox回归模型进行多因素分析。结果 单因素分析显示,术前GCS评分≤5分、脑血肿量>50 mL、血肿破入脑室、高血压病史、气管切开、未采用盐酸纳洛酮联合正中神经电刺激治疗、并发感染的患者昏迷苏醒时间更长(P<0.05); 多因素分析显示,血肿破入脑室、气管切开、并发感染是导致昏迷苏醒时间延长的危险性因素(P<0.05),术前GCS评分高与采用盐酸纳洛酮联合正中神经电刺激治疗可能是昏迷苏醒时间的保护性因素(P<0.05)。结论 血肿破入脑室、气管切开、并发感染、术前GCS评分低是导致老年脑出血患者昏迷苏醒时间延长的主要影响因素,应尽量选择盐酸纳洛酮联合正中神经电刺激治疗方案,强化无菌医疗操作,加强抗感染护理干预,以缩短苏醒时间及改善预后。

The Multivariate Analysis of Awakening Time of Coma after Hematencephalon in Elderly Patients

ObjectiveTo investigate the related factors that affect the awakening time of coma after cerebral hemorrhage in elderly patients, and provide scientific guidance for the further improvement of medical program.Methods From June 2012 to October 2015, the clinical data of 82 elderly comatose patients with hematencephalon in our hospital were collected as the research object. The clinical data of gender, age, preoperative Glasgow Coma Scale(GCS), cerebral hematoma volume, rupture of hematoma into the ventricle, history of hypertension, tracheotomy, treatment methods, accompanying infection were collated as independent variables, while the coma to awakening time as dependent variable. The univariate analysis was conducted to all, and the multivariate analysis was performed with the statistically significant variables by Cox regression model.Results Univariate analysis showed that preoperative GCS≤5, cerebral hematoma volume>50 ml, hematoma ruptured into the ventricle, history of hypertension, tracheotomy, without the use of naloxone hydrochloride combined with electrical stimulation of the median nerve in the treatment, accompanying infection made longer coma time(P<0.05). Multivariate analysis showed that the hematoma ruptured into the ventricle, tracheotomy, and the accompanying infection were the risk factors for longer coma time, and high preoperative GCS score and the treatment of naloxone hydrochloride combined with median nerve electrical stimulation were the protective factors of awakening time(P<0.05).Conclusion The hematoma ruptured into the ventricle, tracheotomy, the accompanying infection and low preoperative GCS score were the risk factors for longer coma time. We should choose the treatment of naloxone hydrochloride combined with median nerve electrical stimulation, strengthen the sterile operation and anti infection nursing intervention, so as to shorten the awakening time and improve the prognosis of patients.