Department of Radiology, School of Medicine, Tongji Hospital, Tongji University, Shanghai, 200065, China.
Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
J Neurol. 2022 Jun;269(6):3015-3025. doi: 10.1007/s00415-021-10888-w. Epub 2021 Nov 17.
This study aimed to explore the factors affecting the outcomes of spontaneous supratentorial cerebral hemorrhage 90 days after surgery.
A total of 256 patients with spontaneous supratentorial intracerebral hemorrhage underwent craniotomy evacuation of hematoma. The control group included 120 patients who received conservative treatment. The patients were divided into two subgroups based on a bifurcation of the modified Rankin Scale (mRS) 90 days after clinical therapeutics: good outcome (mRS score 0-3) and poor outcome (mRS score 4-6). The differences in clinical and imaging data between the two subgroups were analyzed. Based on difference analysis results, a binary logistic regression model was constructed to analyze the influencing factors related to poor outcomes.
The difference analysis results in the surgery group showed statistically significant differences in age, sex, Glasgow Coma Score (GCS) on admission, coronary atherosclerosis, smoking, stroke history, blood glucose, D-dimer, hematoma size, deep cerebral hemorrhage, midline shift, hematoma burst into the ventricle, vortex sign, island sign, and black hole sign. Binary logistic regression analysis showed that deep cerebral hemorrhage, midline shift, and age > 58 years independently correlated with the poor outcomes of patients after surgery. The binary logistic regression results of the control group showed that age > 58 years and GCS ≤ 8 independently correlated with the poor outcomes of patients.
Deep cerebral hemorrhage, midline shift, and age > 58 years significantly increased the risk of adverse prognosis in patients after surgery. The findings might help select the clinical treatment plan and evaluate the postoperative prognosis of patients.
本研究旨在探讨影响手术 90 天后自发性幕上脑出血患者结局的因素。
共 256 例自发性幕上脑内血肿患者接受开颅血肿清除术。对照组包括 120 例接受保守治疗的患者。根据临床治疗后 90 天改良 Rankin 量表（mRS）的分叉，将患者分为两组：良好结局（mRS 评分 0-3）和不良结局（mRS 评分 4-6）。分析两组间临床和影像学数据的差异。基于差异分析结果，构建二项逻辑回归模型，分析与不良结局相关的影响因素。
手术组的差异分析结果显示，年龄、性别、入院时格拉斯哥昏迷评分（GCS）、冠状动脉粥样硬化、吸烟、卒中史、血糖、D-二聚体、血肿大小、脑深部出血、中线移位、血肿破入脑室、涡流征、孤岛征和黑洞征差异有统计学意义。二项逻辑回归分析显示，脑深部出血、中线移位和年龄＞58 岁与患者术后不良结局独立相关。对照组的二项逻辑回归结果显示，年龄＞58 岁和 GCS≤8 与患者不良结局独立相关。
脑深部出血、中线移位和年龄＞58 岁显著增加了术后患者不良预后的风险。这些发现可能有助于选择临床治疗方案并评估患者术后预后。
