高血压性脑出血(HICH)作为全球范围内常见的脑血管疾病,其高致残率与高死亡率给患者及其家庭带来了沉重的负担。传统内科保守治疗虽能在一定程度上控制病情,却难以有效清除血肿,致使患者预后欠佳。故而,外科手术治疗成为HICH的重要手段之一。近些年来,伴随医疗技术的持续进步,超早期与早期外科手术治疗HICH能够显著提升患者的生存率和生活质量,并减少并发症的发生,逐渐受到关注。本文着眼于高血压性脑出血(HICH)的手术治疗时机问题,梳理了近期的研究现状及进展,剖析了多项对比不同手术时机,如超早期(发病至手术时间 Hypertensive intracerebral hemorrhage (HICH) is a common cerebrovascular disease worldwide. Its high disability rate and high mortality rate have brought a heavy burden to patients and their families. Although traditional medical conservative treatment can control the disease to a certain extent, it is difficult to effectively remove the hematoma, resulting in poor prognosis for patients. Therefore, surgical treatment has become one of the important means of HICH. In recent years, with the continuous progress of medical technology, ultra-early and early surgical treatment of HICH can significantly improve the survival rate and quality of life of patients and reduce the incidence of complications, which has gradually gained attention. This article focuses on the timing of surgical treatment of hypertensive intracerebral hemorrhage (HICH), sorts out the current status and progress of recent research, and analyzes the effect of several comparisons of different surgical timings, such as ultra-early (time from onset to operation < 6 h) and early (time from onset to operation 6~24 h), on the prognosis and treatment of patients with hypertensive intracerebral hemorrhage. These studies have shown that ultra-early surgery can significantly improve the survival rate and quality of life of patients, but the risk of rebleeding is higher th
目的:探究高血压性脑出血(hypertensive intracerebral hemorrhage,HICH)病人术后发生低蛋白血症的影响因素,构建Logistic回归方程并评估预测价值。方法:采用便利抽样法,选取2021年11月-2023年10月经医院神经外科手术治疗的146例HICH病人。根据术后有无发生低蛋白血症分为低蛋白血症组、无低蛋白血症组。比较两组临床资料,采用多因素Logistic回归分析HICH术后发生低蛋白血症的影响因素,构建Logistic回归方程模型,使用受试者工作特征(ROC)曲线评估模型的预测价值。结果:146例HICH病人发生术后低蛋白血症者39例,发生率26.71%。低蛋白血症组病人年龄≥65岁、糖尿病占比高于无低蛋白血症组,入院格拉斯哥昏迷量表(glasgow coma scale,GCS)评分、术前白蛋白水平低于无低蛋白血症组,二者比较差异有统计学意义(P<0.05)。年龄≥65岁、糖尿病、入院GCS评分、术前白蛋白水平是HICH病人术后发生低蛋白血症的影响因素(均P<0.05)。构建回归方程Logit(P)=21.934+1.277×年龄≥65岁+1.454×糖尿病+(-0.466)×入院GCS评分+(-0.517)×术前白蛋白,模型Omnibus检验χ^(2)=29.622(P<0.001),Hosmer-Lemeshow检验χ^(2)=7.340(P=0.500),ROC曲线显示模型预测低蛋白血症的曲线下面积(AUC)为0.891[95%CI(0.840,0.942)],P<0.05,灵敏度92.3%,特异度72.9%。结论:年龄≥65岁、糖尿病、入院GCS评分、术前白蛋白是HICH病人术后发生低蛋白血症的影响因素,基于4项指标构建的回归模型对低蛋白血症具有良好预测效能。
