Liliang P C, Liang C L, Lu C H, Chang H W, Cheng C H, Lee T C, Chen H J
Departments of Neurosurgery, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Niaosung Hsiang, Kaohsiung Hsien, Taiwan.
Stroke. 2001 May;32(5):1195-200. doi: 10.1161/01.str.32.5.1195.
The purpose of the present study was to analyze the outcome and outcome predictors of caudate hemorrhage and role of external ventricular drainage in acute hydrocephalus.
Clinical data from 36 consecutive patients with hypertensive caudate hemorrhage was used in the present study. Age, gender, volume of parenchymal hematoma, hematoma in the internal capsule, initial Glasgow Coma Scale (GCS), hydrocephalus, severity of intraventricular hemorrhage, and hemorrhagic dilatation of the fourth ventricle were analyzed for effect on outcome. Effect of external ventricle drainage for hydrocephalus was evaluated by comparing preoperative and postoperative GCS scores.
By univariate analyses, poor outcome was associated with a poor initial GCS score (P=0.016), hydrocephalus (P<0.001), intraventricular hemorrhage severity (P<0.01), and hemorrhagic dilatation of the fourth ventricle (P=0.02). By multivariate analysis, stepwise logistic regression revealed that hydrocephalus was the only independent prognostic factor for poor outcome (P<0.001). Postoperative 48-hour GCS score was better than the preoperative score by use of paired-sample t test (P<0.001).
Hydrocephalus is the most important predictor of poor outcome. External ventricular drainage response for hydrocephalus was good in the present study, whereas an early decision should be made regarding preoperative neurological condition.
本研究旨在分析尾状核出血的结局及结局预测因素，以及外引流在急性脑积水治疗中的作用。
本研究采用36例连续性高血压性尾状核出血患者的临床资料。分析年龄、性别、脑实质血肿体积、内囊血肿、初始格拉斯哥昏迷量表（GCS）评分、脑积水、脑室内出血严重程度及第四脑室出血性扩张对结局的影响。通过比较术前和术后GCS评分评估外引流治疗脑积水的效果。
单因素分析显示，不良结局与初始GCS评分差（P = 0.016）、脑积水（P < 0.001）、脑室内出血严重程度（P < 0.01）及第四脑室出血性扩张（P = 0.02）相关。多因素分析中，逐步逻辑回归显示脑积水是不良结局的唯一独立预测因素（P < 0.001）。采用配对样本t检验，术后48小时GCS评分优于术前评分（P < 0.001）。
脑积水是不良结局最重要的预测因素。本研究中外引流治疗脑积水效果良好，但应根据术前神经功能状态尽早做出决策。
