Ding Yingying, Qi Ming, Zhang Xu, Dong Jirong, Wu Da
Department of Neurosurgery, Yixing People's Hospital Affiliated Jiangsu University, Yixing, Jiangsu Province, 214200, China.
Department of Neurosurgery, Wuxi Clinical College of Anhui Medical University (The 904th Hospital of PLA), Wuxi, Jiangsu Province, 214044, China.
Heliyon. 2024 Mar 8;10(5):e27487. doi: 10.1016/j.heliyon.2024.e27487. eCollection 2024 Mar 15.
Primary pontine hemorrhage (PPH) is a particularly grave form of hemorrhagic stroke, characterized by its significant mortality rate. stereotactic hematoma puncture and drainage is a procedure that has been shown to improve the prognosis of patients with PPH. However, there are currently no established criteria for selecting patients for this procedure. We contrasted the clinical outcomes of PPH patients treated with stereotactic hematoma puncture and drainage with those who received conservative treatment in this study. We conducted logistic regression analysis to identify the risk factors associated with postoperative mortality. A mortality risk nomogram was then constructed using these risk factors. A total of 127 conservatively treated patients and 96 patients who underwent stereotactic hematoma puncture and drainage were included in this study. In the surgical group, the 30-day mortality rate stood at 28.1%, significantly lower than the 43.3% observed in the control group ( = 0.02). Age, along with the Glasgow Coma Scale (GCS) score and hematoma size, were identified as independent risk factors associated with death within 30 days post-surgery. The mortality risk nomogram was well calibrated and discriminatory, with a c-index of 0.878 (95% CI 0.80-0.95) as validated by bootstrapping, and a c-index of 0.849. This study provides a predictive model for selecting patients who are most likely to benefit from stereotactic hematoma puncture and drainage. The results of this study could be helpful to neurosurgeons in their decision-making process. However, further external validation is necessary to confirm these findings.
原发性脑桥出血(PPH)是出血性卒中的一种特别严重的形式,其死亡率很高。立体定向血肿穿刺引流术已被证明可改善PPH患者的预后。然而,目前尚无该手术患者选择的既定标准。在本研究中,我们对比了接受立体定向血肿穿刺引流术治疗的PPH患者与接受保守治疗的患者的临床结局。我们进行了逻辑回归分析以确定与术后死亡率相关的危险因素。然后使用这些危险因素构建了死亡率风险列线图。本研究共纳入127例接受保守治疗的患者和96例接受立体定向血肿穿刺引流术的患者。手术组的30天死亡率为28.1%,显著低于对照组的43.3%(P = 0.02)。年龄、格拉斯哥昏迷量表(GCS)评分和血肿大小被确定为与术后30天内死亡相关的独立危险因素。死亡率风险列线图校准良好且具有鉴别力,经自抽样验证,其c指数为0.878(95%CI 0.80 - 0.95),交叉验证的c指数为0.849。本研究提供了一个预测模型,用于选择最有可能从立体定向血肿穿刺引流术中获益的患者。本研究结果可能有助于神经外科医生的决策过程。然而,需要进一步的外部验证来证实这些发现。