CAJ | 학술논문

目的探讨原发性脑桥出血患者预后及其影响因素。方法以温州卒中登记库为基础，前瞻性连续登记2007年4月至2009年4月温州医学院附属第一医院从发病到入院时间＜24h，并被诊断为原发性脑桥出血的患者。随访1年，记录患者生存状态。应用Kaplan-Meier法进行生存率分析，应用Cox比例风险模型对可能影响患者1年生存率的因素进行分析。结果共收集原发性脑桥出血患者41例，男性27例(65.9％)，女性14例(34.2％)。截止随方终止时，死亡患者共25例，总病死率为61.0％，中位生存时间为(80.0±54.4) d(95％ CI0～186.64)。不同部位的原发性脑桥出血患者1年病死率比较，被盖型(2/11)与基底型(16/22)相比差异有统计学意义(X2 =8.800，P=0.003)，被盖型(2/11)与混合型(7/8)相比差异有统计学意义(x2=8.927，P=0.003)。1年生存组平均血肿体积为(3.043±1.718) ml，死亡组平均血肿体积为(5.984±2.707) ml，两组相比，t=3.661,P=0.001。Cox比例风险模型显示，影响原发性脑桥出血患者1年死亡的主要冈素有：血肿部位(RR =2.428,95％ CI1.055 ～5.587)，血肿体积(RR= 1.283，95％CI1.044- 1.577)，入院时GCS 评分(RR= 3.389，95％CI 1.177～9.756)。结论原发性脑桥出血患者血肿位于脑桥被盖部、血肿体积＜4 ml、入院时GCS评分＞8分时1年预后较好。
목적 탐토원발성뇌교출혈환자예후급기영향인소。방법 이온주졸중등기고위기출，전첨성련속등기2007년4월지2009년4월온주의학원부속제일의원종발병도입원시간＜24h，병피진단위원발성뇌교출혈적환자。수방1년，기록환자생존상태。응용Kaplan-Meier법진행생존솔분석，응용Cox비례풍험모형대가능영향환자1년생존솔적인소진행분석。결과 공수집원발성뇌교출혈환자41례，남성27례(65.9％)，녀성14례(34.2％)。절지수방종지시，사망환자공25례，총병사솔위61.0％，중위생존시간위(80.0±54.4) d(95％ CI0～186.64)。불동부위적원발성뇌교출혈환자1년병사솔비교，피개형(2/11)여기저형(16/22)상비차이유통계학의의(X2 =8.800，P=0.003)，피개형(2/11)여혼합형(7/8)상비차이유통계학의의(x2=8.927，P=0.003)。1년생존조평균혈종체적위(3.043±1.718) ml，사망조평균혈종체적위(5.984±2.707) ml，량조상비，t=3.661,P=0.001。Cox비례풍험모형현시，영향원발성뇌교출혈환자1년사망적주요강소유：혈종부위(RR =2.428,95％ CI1.055 ～5.587)，혈종체적(RR= 1.283，95％CI1.044- 1.577)，입원시GCS 평분(RR= 3.389，95％CI 1.177～9.756)。결론 원발성뇌교출혈환자혈종위우뇌교피개부、혈종체적＜4 ml、입원시GCS평분＞8분시1년예후교호。
Objective To evaluate prognosis and its clinical factors in patients with primary pontine hemorrhage. Methods Patients with primary pontine hemorrhage who were hospitalized in the First Affiliated Hospital of Wenzhou Medical College within 24 hours after stroke onset between April 2007 and April 2009 were registered conscutively. The patients were followed up for one year. Kaplan-Meier methods were used to analyze survival rate. Cox proportional hazards model was used to study risk factors for 1-year mortality. Results A total of 41 patients with primary pontine hemorrhage were studied. Their mean age was (63.5 ± 10. 1 ) years. The overall 1-year mortality rate was 61.0％, the median survival time was (80. 0 ±54.4) days (95％ CI 0-186. 64). After one-year follow-up, the mortality rate in patients with primary dorsal pontine hemorrhage( 18.2％ ) was significantly lower than that in patients with primary ventral pontine hemorrhage(72. 7％ ; x2 = 8. 800, P = 0. 003 ). Patients with massive primary pontine hemorrhage had significantly higher mortality rate than patients with dorsal primary pontine hemorrhage( x2 = 8. 927, P =0. 003). The average hematoma volume of the survivor group and mortality group was (3. 043 ± 1. 718) ml and (5. 984 ± 2. 707) ml, respectively, showing statistical significance (t = 3. 661, P = 0. 001 ). Analysis with Cox proportional hazards model showed that the risk factors associated with mortality were hematoma location ( RR = 2. 428, 95 ％ CI 1. 055-5. 587 ), hematoma volume ( RR = 1. 283, 95 ％ CI 1. 044-1. 577 ),GCS score on admission(RR =3. 389, 95％ CI 1. 177-9. 756). Patients with pontine hematomas in dorsal had a significantly better outcome than in other locations. Conclusions The survival and prognosis in primary dorsal pontine hemorrhage are better than with hemorrhaging in other parts of pontine. A significant correlation was observed between poor prognosis and hematoma volume, hematoma location and GCS score on admission.