2025 年第 6 期 第 20 卷

影响自发性幕上脑出血手术预后的相关因素分析

Analysis of the related factors affecting the surgical prognosis of spontaneous supratentorial intracerebral hemorrhage

作者：宋平李知阳雷盼华秋伟高论江洪祥周龙叶晖陈谦学蔡强

英文作者：Song Ping Li Zhiyang Lei Pan Hua Qiuwei Gao Lun Jiang Hongxiang Zhou Long Ye Hui Chen Qianxue Cai Qiang

单位：武汉大学人民医院神经外科，武汉430060

英文单位：Department of Neurosurgery Renmin Hospital of Wuhan University Wuhan 430060 China

关键词：自发性幕上脑出血；神经内镜；微创手术；预后

英文关键词：Spontaneoussupratentorialintracerebralhemorrhage;Neuroendoscopy;Minimallyinvasivesurgery;Prognosis

• 摘要：

• 目的 探讨影响自发性幕上脑出血（SSICH）患者手术预后的相关因素。方法 回顾性收集2018年12月至2021年10月武汉大学人民医院神经外科收治的294例SSICH患者的临床资料。根据手术方法的不同分为神经内镜组（A组）、钻孔引流组（B组）和开颅血肿清除组（C组）。记录并分析3种手术疗效及主要并发症情况，并基于3D Slicer软件对血肿和水肿体积进行量化计算；采用单因素、多因素Logistic回归分析筛选影响患者预后的危险因素。结果 本研究共纳入294例患者，其中A组126例、B组98例、C组70例。3组血肿清除率、手术时间、出院格拉斯哥昏迷量表（GCS）评分比较差异均有统计学意义（均P＜0.001），其中A组血肿清除率、出院GCS评分最高，B组手术时间最短。术后主要并发症方面，3组术后再出血比例、第7天水肿带直径、置管准确率、引流管拔除时间比较差异均有统计学意义（均P＜0.05）。3组术后残余血肿体积、术后水肿峰值体积比较差异均有统计学意义（均P＜0.05），且二者呈正相关（r=0.414，P＜0.001）。多因素Logistic回归分析显示，入院GCS评分、术前血肿体积、术前CT血肿形态不规则、发病至手术时间、术后血压控制不良、手术方式、出血部位、术后脑水肿及脑出血评分均是SSICH预后的独立危险因素(均P＜0.05)。结论 神经内镜可以有效清除血肿，降低再出血及脑水肿，筛选影响SSICH患者预后的独立危险因素，可优化治疗，改善患者的整体预后。

• Objective To investigate the related factors affecting the surgical prognosis of patients with spontaneous supratentorial intracerebral hemorrhage (SSICH). Methods The clinical data of 294 patients with SSICH admitted to Department of Neurosurgery, Renmin Hospital of Wuhan University from December 2018 to October 2021 were retrospectively collected. According to the different surgical methods , the patients were divided into neuroendoscopy group (group A), drilling drainage group (group B) and craniotomy hematoma removal group (group C). The efficacy and major complications of the three procedures were recorded and analyzed, and the volume of hematoma and edema was quantitatively calculated based on 3D Slicer software. Univariate and multivariate Logistic regression analysis were used to screen the risk factors affecting the prognosis of patients. Results A total of 294 patients were enrolled in this study, including 126 patients in group A, 98 patients in group B and 70 patients in group C. There were significant differences in hematoma clearance rate, operation time and Glasgow coma scale (GCS) score at discharge among the three groups (all P<0.001), among which group A had the highest hematoma clearance rate and GCS score at discharge, and group B had the shortest operation time. In terms of postoperative complications, there were significant differences in the proportion of postoperative rebleeding, the diameter of edema zone on the 7th day, the accuracy of catheterization, and the removal time of drainage tube among the three groups (all P<0.05). There were significant differences in postoperative residual hematoma volume and postoperative edema peak volume among the three groups (all P<0.05), and the two were positively correlated (r=0.414, P<0.001). Multivariate Logistic regression analysis showed that GCS score at admission, preoperative hematoma volume, irregular shape of hematoma on preoperative CT, time from onset to operation, poor postoperative blood pressure control, surgical method, bleeding site, postoperative cerebral edema and cerebral hemorrhage score were independent risk factors for the prognosis of SSICH (all P<0.05). Conclusion Neuroendoscopy can effectively remove hematoma, reduce rebleeding and brain edema, screen independent risk factors affecting the prognosis of patients with SSICH, optimize treatment, and improve the overall prognosis of patients.