文章摘要
潘梦鹏 ，莫海畲 ，伍国锋 ，王丽琨 ，任思颖.头颅CT血肿密度异质性 对微创颅内血肿清除术后再出血的预测能力分析[J].神经损伤功能重建,2024,(6):338-342
头颅CT血肿密度异质性 对微创颅内血肿清除术后再出血的预测能力分析
Analysis of the Predictive Ability of Hematoma Density Heterogeneity on Postoperative Re⁃bleeding after Minimally Invasive Intracranial Hematoma Removal on Cranial CT
  
DOI：
中文关键词: 脑出血  微创颅内血肿清除术  血肿密度异质性  术后再出血
英文关键词: intracerebral hemorrhage  minimally invasive surgery  hematoma density heterogeneity  postoperative rebleeding
基金项目:贵州省科技计划项 目（可视化立体定 向微创技术治疗颅 内出血暨病灶区灌 注6KAPOE减轻继 发性脑损伤的临床 基础研究，No. 黔科 合支撑【2021】一般 071）；贵州省优秀 青年科技人才项目 （脑出血、耐药性癫 痫的基础及临床研 究，No. 黔科合平台 人才【2021】5612）； 贵州省科技计划项 目（亚致死性热消 融 温 度 通 过 活 化 AKT 调 节 MCL-1 增强PTC细胞侵袭 性 机 制 研 究 ，No. 黔 科 合 基 础 -ZK [2023]一般356）
作者单位
潘梦鹏1 ，莫海畲1 ，伍国锋2 ，王丽琨2 ，任思颖2 1. 贵州医科大学附 属医院/临床医学院 2. 贵州医科大学附 属医院急诊医学科 
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中文摘要:
      目的：分析头颅CT血肿密度异质性对微创颅内血肿清除术（MIS）治疗脑出血术后再出血的预测能 力。方法：连续性纳入2015年1月至2022年6月在贵州医科大学附属医院急诊神经科收治的脑出血患者 515例，所有患者均接受MIS治疗。根据头颅CT血肿密度异质性将患者分为血肿密度均匀组160例和血肿 密度不均匀组355例，比较2组的临床资料、影像学资料情况；再根据患者有无术后再出血分为术后再出血 组59例和术后未出血组456例，进行术后再出血的单因素分析，并采用二元Logistic回归模型分析血肿密 度均匀程度与术后再出血的相关性。结果：血肿密度不均匀组术后再出血发生率为13.80%，高于对照组的 6.25%（P＜0.05）。与术后未出血组相比，术后再出血组中高血压病史患者的比例较低（P＜0.05）、血肿密度 不均匀患者的比例较高（P＜0.05）、出院改良Rankin量表（mRS）评分较高（P＜0.01）；二元多因素Logistic回 归分析结果显示血肿密度不均匀（OR=2.499，95% CI 1.226-5.092，P=0.012）是导致术后再出血的独立危险 因素；受试者工作曲线分析血肿密度不均匀预测术后再出血的敏感度、特异度、阳性预期值、阴性预期值和 约登指数分别为83.1%、32.9%、55.3%、66%和0.16。结论：头颅CT血肿密度不均匀对微创颅内血肿清除术 治疗脑出血术后再出血有一定的预测价值。
英文摘要:
      To analyze the predictive ability of hematoma density heterogeneity on postoperative rebleeding in patients undergoing minimally invasive surgery (MIS) for intracerebral hemorrhage. Methods: Five hundred and fifteen patients with intracerebral hemorrhage, who were hospitalized in the Department of Emergency Neurology at the Affiliated Hospital of Guizhou Medical University from January 2015 to June 2022, were included in this study. All patients were treated with MIS. Based on the heterogeneity of hematoma density on cranial CT, patients were divided into a homogeneous hematoma density group (160 cases) and a heterogeneous hematoma density group (355 cases). Clinical and radiological data between the two groups were compared. Patients were further divided into a postoperative rebleeding group (59 cases) and a non-rebleeding group (456 cases) based on the presence or absence of postoperative rebleeding. Univariate analysis of postoperative rebleeding was conducted, and binary logistic regression model was used to analyze the correlation between the degree of hematoma density uniformity and postoperative rebleeding. Results: The incidence of postoperative rebleeding in the heterogeneous hematoma density group was 13.80%, which was higher than that in the control group (6.25% ) (P<0.05). Compared with the non-rebleeding group, the proportion of patients with a history of hypertension was lower (P<0.05), the proportion of patients with heterogeneous hematoma density was higher (P<0.05), and the modified Rankin Scale (mRS) score at discharge was higher (P<0.01) in the rebleeding group. Binary multivariate logistic regression analysis showed that heterogeneous hematoma density (OR=2.499, 95% CI 1.226-5.092, P=0.012) was an independent risk factor for postoperative rebleeding. Receiver operating characteristic curve analysis showed that the sensitivity, specificity, positive predictive value, negative predictive value, and Youden index of predicting postoperative rebleeding by heterogeneous hematoma density were 83.1%, 32.9%, 55.3%, 66%, and 0.16, respectively. Conclusion: Cranial CT hematoma density heterogeneity has certain predictive value for postoperative rebleeding in patients undergoing MIS for intracerebral hemorrhage.
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