立体定向精密抽吸治疗原发性脑干出血的疗效及影响因素分析

Q4 Medicine

中华神经外科杂志 Pub Date : 2019-11-28 DOI:10.3760/CMA.J.ISSN.1001-2346.2019.11.004

Liu Fengqiang, Wang Zefeng, Yu Xiaobo, Zheng Jian, Zhang Yang, Chen Gao, Z. Jianmin

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引用次数: 1

摘要

目的探讨立体定向精确抽吸治疗原发性脑干出血的疗效及影响因素。方法收集2014年3月至2018年9月浙江大学医学院第二附属医院神经外科行立体定向精准抽吸术的原发性脑干出血患者47例，收集临床资料。根据脑桥血肿的位置选择手术入路。同时，术后脑积水患者行脑室外引流。术后第1天CT检查颅内残余血肿体积。术后30天通过电话或门诊随访确认所有患者的病情。通过单因素分析和logistic回归分析，探讨影响患者生存的临床因素，并绘制ROC曲线，判断其预测价值。结果47例患者术中无死亡报告。术后第1天CT扫描显示，47例患者颅内残余血肿体积平均为(2.7±0.9)ml (0 ~ 15.5 ml)，血肿清除率为(75.0±24.2%)%。30天内死亡7例，存活40例。死亡率为14.9%。单因素分析显示，血肿分类是影响术后死亡率的因素(χ2=13.689, P=0.033)，多因素logistic回归分析证实了这一点(OR=0.053, 95% CI: 0.744 ~ 0.992, P=0.004)。进一步的ROC曲线结果显示，血肿分型预测患者预后的敏感性为85.7%，特异性为82.5%。结论脑干血肿的新分类适合手术计划，有利于预测患者30天死亡率。关键词:脑出血;脑干;治疗效果;因子分析、统计学

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Efficiency and influence factors of stereotactic precision aspiration in the treatment of primary brain stem hemorrhage

Objective To investigate the efficiency and influence factors of stereotactic precise aspiration in treatment of primary brainstem hemorrhage. Methods A total of 47 patients with primary brainstem hemorrhage who underwent stereotactic precision aspiration from March 2014 to September 2018 at Department of Neurosurgery, the Second Affiliated Hospital of Zhejiang University School of Medicine were enrolled and their clinical data were collected. Surgical approach was chosen according to the location of the pons where the hematoma was located. Meanwhile, patients with postoperative hydrocephalus underwent external ventricular drainage. Intracranial residual hematoma volume was evaluated by CT scan on the first day post operation. Further follow-up at 30 days post surgery by phone or clinic was conducted to confirm the status of all patients. Univariate analysis and logistic regression analysis were performed to investigate the clinical factors associated with survival of patients.(ROC) curvecurve was further drawn to judge its predictive value. Results Among 47 patients, no death was reported during the operation. CT scan at day 1 post surgery showed that the average of intracranial residual hematoma volume in 47 patients was (2.7±0.9) ml (0-15.5 ml), and the clearance rate of hematoma was (75.0±24.2)%. In this series, 7 cases died and 40 survived within 30 days. The mortality rate was 14.9%. Univariate analysis revealed that classification of hematoma was the factor influencing postoperative mortality (χ2=13.689, P=0.033), which was confirmed by multiple logistic regression analysis (OR=0.053, 95% CI: 0.744-0.992, P=0.004). Further ROC curve results showed that the sensitivity and specificity of hematoma classification in predicting the prognosis of patients were 85.7% and 82.5%, respectively. Conclusions The new classification of brainstem hematoma is suitable for surgical planning and beneficial for prediction of the 30-day mortality. Key words: Cerebral hemorrhage; Brain stem; Treatment outcome; Factor analysis, statistical

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来源期刊

中华神经外科杂志 Medicine-Surgery

CiteScore

0.10

自引率

0.00%

发文量

10706

期刊介绍： Chinese Journal of Neurosurgery is one of the series of journals organized by the Chinese Medical Association under the supervision of the China Association for Science and Technology. The journal is aimed at neurosurgeons and related researchers, and reports on the leading scientific research results and clinical experience in the field of neurosurgery, as well as the basic theoretical research closely related to neurosurgery.Chinese Journal of Neurosurgery has been included in many famous domestic search organizations, such as China Knowledge Resources Database, China Biomedical Journal Citation Database, Chinese Biomedical Journal Literature Database, China Science Citation Database, China Biomedical Literature Database, China Science and Technology Paper Citation Statistical Analysis Database, and China Science and Technology Journal Full Text Database, Wanfang Data Database of Medical Journals, etc.