- 學位論文
⾃發性腦出⾎之⼩腦出⾎術後兩年預後分析
Analysis of 2-Year Postoperative Outcomes of Spontaneous Cerebellar Hemorrhage in Spontaneous Intracerebral Hemorrhage
摘要
腦血管疾病位居民國一百零八年國人十大死因第四位。腦血管疾病可分為兩種：缺血性中風及出血性中風。而自發性腦出血則為出血性中風裡最常見的一種診斷，比例約占腦血管疾病的百分之十。其中自發性小腦出血占自發性腦出血的百分之十。自發性小腦出血具有高死亡率和高致病率，其可能威脅患者生命。因此，建立可預測預後之因子對於臨床決策至關重要。利用術後的臨床和影像學參數作為預測因子兼具實用性和可操作性，但這種方法尚未在文獻中受到廣泛討論。本研究欲探討可預測接受手術治療的自發性小腦出血患者之術後兩年預後和死亡率的預後因子。這項回顧性研究納入了二零零七年至二零一一年間接受神經外科手術治療的四十八位自發性小腦出血患者，利用相關性分析評估患者之臨床和影像學參數與出院時的美國國衛院腦中風評估指數及術後兩年預後 (根據格拉斯哥預後指數) 之間的相關性。患者的平均年齡為六十三歲，總死亡率為百分之三十五點四，所有患者均接受神經外科手術治療，包括枕下顱骨切除和/或腦室外引流手術。其中十四名患者 (占百分之二十九點二) 根據其術後兩年之格拉斯哥預後指數顯示具有良好的預後。患者術後兩年預後與手術方法無統計學上的意義。單變量分析結果顯示，良好的術後預後結果與入院時的格拉斯哥昏迷指數、術前格拉斯哥昏迷指數、出院時的美國國衛院腦中風評估指數以及小腦出血量之間具有顯著相關。多變量分析結果證實，出院時的美國國衛院腦中風評估指數為預測術後兩年預後的主要指標。接受神經外科手術的自發性小腦患者，其出院時的美國國衛院腦中風評估指數提高一分，將使其術後兩年預後不良的可能性增加百分之二十八點五。多變量分析亦顯示，出院時的美國國衛院腦中風評估指數與死亡率之間存在顯著相關性。綜合以上，我們發現出院時的美國國衛院腦中風評估指數可作為接受手術治療的自發性小腦出血患者術後兩年之預後和死亡率的預測因子。
並列摘要
Cerebrovascular disease is the 4th leading cause of death in Taiwan. In general, cerebrovascular disease can be divided into ischemic and hemorrhagic stroke. Of hemorrhagic stroke, intracerebral hemorrhage is the most common disease. Intracerebral hemorrhage accounts for approximately 10% of all strokes and spontaneous cerebellar hemorrhage comprises around 10% of intracerebral hemorrhage. Spontaneous cerebellar hemorrhage is a potentially life‑threatening condition with high patient mortality and morbidity; consequently, establishing the factors that influence outcome is essential for clinical decision‑making. The use of clinical and radiographic predictors of the postoperative outcome is practical and feasible for this purpose, but this approach has not been widely addressed in the literature. The aim of this thesis was to investigate the prognostic factors that predict the 2-year postoperative outcome and mortality in patients with spontaneous cerebellar hemorrhage who undergo surgical intervention. This retrospective study included 48 consecutive patients with spontaneous cerebellar hemorrhage who underwent neurosurgical intervention between 2007 and 2011. A correlation analysis was performed to examine the possible links between the clinical and radiographic parameters, the National Institutes of Health Stroke Scale score at discharge, and the 2-year postoperative outcome (defined according to the Glasgow Outcome Scale). The mean patient age was 63 years and the overall mortality rate was 35.4%. All patients underwent neurological surgery, which included suboccipital craniectomy and/or external ventricular drainage. Fourteen patients (29.2%) had good outcomes according to the 2-year postoperative Glasgow Outcome Scale. The 2-year postoperative outcome was not statistically associated with the operative methods. Univariate analysis revealed a significant association between favorable outcome and the Glasgow Coma Scale on admission, the preoperative Glasgow Coma Scale, the National Institutes of Health Stroke Scale score at discharge, and the hematoma volume. Multivariate analysis confirmed the National Institutes of Health Stroke Scale score at discharge as the major predictor of the 2-year postoperative outcome. An increase of one point in a patient's National Institutes of Health Stroke Scale score at discharge following neurological surgery increased the probability of a poor 2-year postoperative outcome by 28.5%. The multivariate analysis also revealed a significant association between the National Institutes of Health Stroke Scale score and mortality. Taken together, our findings identify the National Institutes of Health Stroke Scale score as a prognostic factor for 2-year postoperative outcome and mortality in patients with spontaneous cerebellar hemorrhage who undergo surgical intervention.