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目的探讨APACHⅡ评分在小脑出血治疗决策和疗效评价中的应用价值。方法对68例经头部CT确诊的小脑出血患者,分别统计入院时APACHEⅡ评分、血肿量、治疗方式(保守治疗和微创手术治疗)、30d实际病死率。根据APACHEⅡ评分计算出预测病死率,以预测病死率50%和75%两个四分位点将观察样本分为三个段别,比较各段别不同治疗方式对预后的影响。结果 68例小脑出血患者中评分<20分者共26例,平均预测病死率35.54%(23.36%~49.5%),保守治疗20例,微创手术治疗6例,疗效均显著,30d病死率均为0%;评分20~27分者共34例,平均预测病死率64.68%(53.15%~73.15%),保守治疗9例,死亡6例,微创手术治疗25例,死亡5例,微创手术治疗组30d病死率明显低于保守治疗组及预测病死率(P<0.01);评分≥27分者共8例,平均预测病死率83.41%(75.91%~89.75%),保守治疗3例,死亡3例,微创手术治疗5例,死亡4例,保守治疗和微创手术治疗效果均较差,与预测病死率无统计学差异。结论 A-PACHEⅡ评分在小脑出血治疗决策和疗效评价中有重要的参考价值。对于APACHEⅡ评分在20~27分之间的小脑出血患者,微创手术治疗能明显降低其病死率,改善预后。
Objective To investigate the value of APACH Ⅱ in the treatment of cerebellar hemorrhage and the evaluation of its curative effect. Methods Sixty-eight patients with cerebellar hemorrhage diagnosed by head CT were enrolled in this study. APACHEⅡscore, hematoma volume, treatment (conservative treatment and minimally invasive surgery), and actual mortality at 30 days were calculated. According to the APACHEⅡscore, the predicted mortality was calculated, and the observed samples were divided into three sections by predicting the mortality of 50% and 75% respectively. The effects of different treatment methods on the prognosis were compared. Results Among the 68 patients with cerebellar hemorrhage, the scores of <20 were 26, the average predicted mortality was 35.54% (23.36% ~ 49.5%), conservative treatment of 20 cases, minimally invasive surgery in 6 cases, the effect was significant, 30d mortality were (0%). There were 34 cases with scores of 20-27, the average predicted mortality rate was 64.68% (53.15% ~ 73.15%). Nine cases were treated conservatively, 6 died, 25 cases were treated with minimally invasive surgery, 5 cases died, The 30-day mortality rate in the surgical treatment group was significantly lower than that in the conservative treatment group and in the predictive case-fatality rate (P <0.01). Eight patients with a score of ≥27 had an average predicted mortality of 83.41% (75.91% -89.75%), conservative treatment in 3, 3 cases were killed, 5 cases were treated by minimally invasive surgery and 4 cases were died. The conservative treatment and minimally invasive surgical treatment were poor, and the predicted mortality was not statistically different. Conclusion A-PACHEⅡscore in cerebellar hemorrhage treatment decision-making and efficacy evaluation has important reference value. For patients with cerebellar hemorrhage with an APACHE II score of 20-27, minimally invasive surgery can significantly reduce its mortality and improve prognosis.