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目的 用数学方法评估与预测幕上脑出血患者颅腔容积急性代偿能力,并分析主要影响因素。方法 78例幕上急性脑出血量大于30 ml者被纳入本项研究。血肿量最大者155 ml,最小者30 ml,平均(65.2±10.8)ml。所有病例均接受药物治疗外,29例接受血肿抽吸术,15例接受血肿抽吸联合侧脑室外引流术。以“昏迷”与“一侧散瞳”为颅腔容积代偿状态指标,对包括年龄、性别、高血压病史年限、血肿量、血肿中心与正常中线结构距离、中线结构的移位幅度、血肿中心OM层面数、OM50层面时顶枕径与双颞径乘积、CT片上脑萎缩程度、脑室积血评分、外科干预、干预的方法、血肿抽出量等13项影响因素进行多因素回归分析。结果“昏迷”的主要影响因素有“血肿量”与“脑室积血评分”,其预测方程为logitP=0.458X_(脑室出血评分)+0.08X_(血肿量)-4.009。出血量50.1 ml是半数患者出现昏迷的界点值;“一侧散瞳”的主要影响因素有“血肿量”与“脑室积血评分”,其预测方程为logitP=0.413X_(脑室出血评分)+0.057X_(血肿量)-3.900。出血量68.4 ml是半数患者出现一侧散瞳的界点值。结论 幕上脑出血时急性颅腔容积代偿能力是有限的。一次性出血量超过50 ml,则可引起多数病例的颅腔容积相对失代偿;一次性出血量超过69 ml,则可引起多数病例的颅腔?
Objective To evaluate and predict the acute compensatory capacity of cranial cavity in patients with supratentorial hemorrhage by mathematical method and to analyze the main influencing factors. Methods 78 cases of supratentorial acute cerebral hemorrhage greater than 30 ml were included in this study. The largest amount of hematoma 155 ml, the smallest 30 ml, an average of (65.2 ± 10.8) ml. All cases were treated with drugs, 29 cases received hematoma aspiration, 15 cases received hematoma suction combined with lateral ventricle drainage. To “coma” and “dilated side” for the cranial cavity volume compensatory state indicators, including age, gender, history of hypertension, hematoma, hematoma center and normal center structure distance, the shift of the midline structure, hematoma center Multivariate regression analysis was performed on 13 factors including the number of OM layers, the product of the top and the second temporal diameters at the OM50 level, the degree of atrophy on the CT slice, the ventricular hemorrhage score, the surgical intervention, the intervention method and the hematoma withdrawal volume. Results The main influencing factors of “coma” were “hematoma volume” and “ventricular hemorrhage score”. The predictive equation was logitP = 0.458X_ (ventricular hemorrhage score) + 0.08X_ (hematoma volume) -4.009. The amount of bleeding was 50.1 ml, which was the threshold point of coma for half of patients. The main influencing factors of “dilation” were “hematoma volume” and “ventricular hemorrhage score”. The predictive equation was logitP = 0.413X_ (ventricular hemorrhage score) + 0.057X_ (hematoma amount) -3.900. The amount of bleeding 68.4 ml is half the number of patients with mydriatic boundary value. Conclusion The supratentorial intracerebral hemorrhage acute cranial cavity volume compensatory capacity is limited. One-time bleeding more than 50 ml, can cause the relative volume of the cranial cavity in most cases decompensation; one-time bleeding more than 69 ml, can cause most cases of the cranial cavity?