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目的:探讨基底节区脑出血患者发生早期神经功能恶化(END)的危险因素及临床急救,并通过Logistic回归分析其危险因素。方法:选取2012-01-2014-12我院神经内科收治的122例基底节区脑出血患者,根据其是否发生END,分为END组(n=60)和非END组(n=62),对比分析2组患者一般临床资料、实验室检查资料以及影像学资料,并进行多因素的Logistic回归分析,判定基底节区脑出血患者发生END的独立危险因素;将END组患者随机分为观察组和对照组,每组各30例,观察组患者在内科保守方式基础上行超早期微创穿刺引流组术急救,对照组行内科保守方式,对比2组患者的临床效果。结果:END组患者的NIHSS评分、白细胞计数(WBC)、血清汇总肿瘤坏死因子-α(TNF-α)浓度、白介素-6(IL-6)浓度、颅内血肿体积、出血是否破入脑室比例均显著高于非END组(P<0.05),基底节区脑出血患者发生END的独立危险因素是出血破入脑室和WBC;观察组患者的临床治愈率显著高于对照组(100.00%vs.83.33%,P<0.05)。结论:基底节区脑出血患者WBC越高、出血破入脑室概率越大,END的发生率就越高,患者预后便越差;当基底节区脑出血患者发生END时应立即采取超早期微创穿刺引流术进行临床急救,疗效显著,值得临床进一步推广使用。
Objective: To investigate the risk factors and clinical emergency of early neurological deterioration (END) in patients with basal ganglia cerebral hemorrhage and to analyze the risk factors by Logistic regression. Methods: One hundred and twenty-two patients with intracerebral hemorrhage in the basal ganglia treated by Department of Neurology from January 2012 to December 2014 were enrolled into the END group (n = 60) and the non-END group (n = 62) according to whether they occurred or not. The clinical data, laboratory test data and imaging data of two groups of patients were compared and analyzed. Logistic regression analysis was used to determine the independent risk factors of END in patients with basal ganglia hemorrhage. The patients in END group were randomly divided into observation group And control group, 30 cases in each group. The patients in the observation group were treated with ultra-early minimally invasive puncture and drainage group on the basis of conservative medical methods. The control group was given conservative medical treatment and compared the clinical effects of the two groups. Results: The NIHSS score, white blood cell count (WBC), TNF-α, IL-6, intracranial hematoma volume and proportion of bleeding in the END group Were significantly higher than those in non-END group (P <0.05). The independent risk of END in patients with basal ganglia intracerebral hemorrhage was hemorrhage broken into ventricles and WBC. The clinical cure rate in observation group was significantly higher than that in control group (100.00% vs. 83.33%, P <0.05). Conclusion: The higher the WBC in patients with basal ganglia hemorrhage, the higher the probability of hemorrhage breaking into the ventricle, the higher the incidence of END, and the poorer the prognosis of patients. When the END occurs in patients with cerebral hemorrhage in basal ganglia, the ultra early micro Create a puncture and drainage for clinical first aid, significant effect, it is worth further clinical use.