Hu Yuanyuan, Cao Jingwei, Hou Xianzeng, Liu Guangcun
Department of Neurosurgery, Qianfoshan Hospital affiliated to Shandong University, Jinan, Shandong, People's Republic of China.
Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University, Jinan, Shandong, People's Republic of China.
World Neurosurg. 2017 Mar;99:624-629. doi: 10.1016/j.wneu.2016.12.102. Epub 2016 Dec 31.
Reports suggest that patients with spontaneous intracerebral hemorrhage (ICH) can benefit from minimally invasive surgery, but the inclusion criterion for operation is controversial. This article analyzes factors affecting the 30-day prognoses of patients who have received minimally invasive surgery and proposes a simple grading scale that represents clinical operation effectiveness.
The records of 101 patients with spontaneous ICH presenting to Qianfoshan Hospital were reviewed. Factors affecting their 30-day prognosis were identified by logistic regression. A clinical grading scale, the MIS score, was developed by weighting the independent predictors based on these factors.
Univariate analysis revealed that the factors that affect 30-day prognosis include Glasgow coma scale score (P < 0.01), age ≥80 years (P < 0.05), blood glucose (P < 0.01), ICH volume (P < 0.01), operation time (P < 0.05), and presence of intraventricular hemorrhage (P < 0.001). Logistic regression revealed that the factors that affect 30-day prognosis include Glasgow coma scale score (P < 0.05), age (P < 0.05), ICH volume (P < 0.01), and presence of intraventricular hemorrhage (P < 0.05). The MIS score was developed accordingly; 39 patients with 0-1 MIS scores had favorable prognoses, whereas only 9 patients with 2-5 MIS scores had poor prognoses.
The MIS score is a simple grading scale that can be used to select patients who are suited for minimal invasive drainage surgery. When MIS score is 0-1, minimal invasive surgery is strongly recommended for patients with spontaneous cerebral hemorrhage. The scale merits further prospective studies to fully determine its efficacy.
有报告表明，自发性脑出血（ICH）患者可从微创手术中获益，但手术的纳入标准存在争议。本文分析了影响接受微创手术患者30天预后的因素，并提出了一种代表临床手术效果的简单分级量表。
回顾性分析千佛山医院收治的101例自发性ICH患者的病历。通过逻辑回归确定影响其30天预后的因素。基于这些因素对独立预测因子进行加权，制定了一种临床分级量表，即MIS评分。
单因素分析显示，影响30天预后的因素包括格拉斯哥昏迷量表评分（P<0.01）、年龄≥80岁（P<0.05）、血糖（P<0.01）、ICH体积（P<0.01）、手术时间（P<0.05）和脑室内出血的存在（P<0.001）。逻辑回归显示，影响30天预后的因素包括格拉斯哥昏迷量表评分（P<0.05）、年龄（P<0.05）、ICH体积（P<0.01）和脑室内出血的存在（P<0.05）。据此制定了MIS评分；MIS评分为0 - 1分的39例患者预后良好，而MIS评分为2 - 5分的患者中只有9例预后较差。
MIS评分是一种简单的分级量表，可用于选择适合微创引流手术的患者。当MIS评分为0 - 1分时强烈建议对自发性脑出血患者进行微创手术。该量表值得进一步进行前瞻性研究以充分确定其疗效。
