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CT征象预测原发性脑干出血患者意识障碍程度的价值
Predictive value of CT signs for disorders of consciousness in patients with primary brainstem hemorrhage
- 第三军医大学学报 2021年43卷第15期 页码：1437-1443
- 作者机构：
1.400037 重庆，陆军军医大学(第三军医大学)第二附属医院：放射科
2.400037 重庆，陆军军医大学(第三军医大学)第二附属医院：疼痛与康复医学科
3.400038 重庆，陆军军医大学(第三军医大学)基础医学院生理学教研室，脑与智能研究院
- 作者简介：
[刘勇，E-mail: lzsht@aliyum.com LIU Yong, E-mail: lzsht@aliyum.com
[姚忠祥，E-mail: yaozhx@yahoo.com YAO Zhognxiang, E-mail: yaozhx@yahoo.com
- 基金信息：国家自然科学基金创新研究群体项目(31921003);利益冲突声明 所有作者声明无利益冲突
DOI：10.16016/j.1000-5404.202102093
中图分类号： R743.34;R749.13;R814.42收稿：2021-02-20，
修回：2021-06-04，
纸质出版：2021-08-15
- 稿件说明：
移动端阅览
刘国芳, 孙娟, 陈珍珍, 等. CT征象预测原发性脑干出血患者意识障碍程度的价值[J]. 第三军医大学学报, 2021,43(15):1437-1443.
Guofang LIU, Juan SUN, Zhenzhen CHEN, et al. Predictive value of CT signs for disorders of consciousness in patients with primary brainstem hemorrhage[J]. Journal of Third Military Medical University, 2021, 43(15): 1437-1443.
刘国芳, 孙娟, 陈珍珍, 等. CT征象预测原发性脑干出血患者意识障碍程度的价值[J]. 第三军医大学学报, 2021,43(15):1437-1443. DOI： 10.16016/j.1000-5404.202102093.
Guofang LIU, Juan SUN, Zhenzhen CHEN, et al. Predictive value of CT signs for disorders of consciousness in patients with primary brainstem hemorrhage[J]. Journal of Third Military Medical University, 2021, 43(15): 1437-1443. DOI： 10.16016/j.1000-5404.202102093.
摘要
目的
2
分析CT征象对原发性脑干出血患者意识障碍程度的预测价值。
方法
2
收集2011年8月至2020年10月陆军军医大学第二附属医院收治的377例脑干出血患者，筛选出107例原发性脑干出血患者，按意识障碍程度分为神志清醒、嗜睡、昏睡、昏迷4个等级，先使用Mann-Whitney
U
检验与Spearman相关性分析对可能影响意识障碍程度的因素(性别、年龄、CT征象、出血分期)进行单因素分析，对具有统计学意义的因素再行有序多分类Logistic回归分析，探讨其与意识障碍程度的关系，寻找预测意识障碍程度的CT征象。
结果
2
Mann-Whitney
U
检验提示性别与意识障碍程度无显著相关，而脑干出血是否破入脑室、是否累及中脑与意识障碍程度显著相关。Spearman相关性分析发现年龄与意识障碍程度无显著相关，而出血分期、出血平均CT值与意识障碍程度呈弱相关，出血形态差异性、密度异质性与意识障碍程度呈中等强度相关，出血量及血肿横断位最长径线与意识障程度呈强相关。进一步对单因素分析与意识障碍程度有统计学意义的因素进行有序多分类Logistic回归分析提示: ①脑干出血患者出血量越多或血肿横断位最长径越长，意识障碍程度越严重；②脑干出血量
>
5~10 mL患者意识障碍程度至少加重一级的可能性是≤2 mL患者的8.05倍；血肿横断位最长径线
>
3~4 cm患者意识障碍程度至少加重一级的可能性是≤2 cm患者的16.66倍；③出血形态差异性、密度异质性、出血是否累及中脑、是否破入脑室与意识障碍程度无显著相关。
结论
2
原发性脑干出血患者出血量和血肿横断位最长径线长度与意识障碍程度呈正相关，且当脑干出血量>5~10 mL或血肿横断位最长径线>3~4 cm时能提示意识障碍程度等级变化。
Abstract
Objective
2
To analyze the value of CT signs in the prediction of disorders of consciousness (DOC) in patients with primary brainstem hemorrhage (PBH).
Methods
2
A total of 377 patients with brainstem hemorrhage admitted to the Second Affiliated Hospital of Army Medical University from August 2011 to October 2020 were recruited
and 107 patients with PBH were screened out. According to the level of their consciousness
they were divided into 4 levels
that is
consciousness
somnolence
sopor and coma. Mann-Whitney
U
and Spearman rank correlation tests were used to perform univariate analysis on the factors that may affect DOC (gender
age
CT signs
bleeding stage)
and ordinal multinomial logistic regression analysis was carried out for those with significance (
P
<
0.05) to explore the correlation of these indicators with consciousness level in order to explore the CT signs that can predict the level of DOC.
Results
2
Mann-Whitney
U
test showed that gender had no significant correlation with DOC
while whether being broken into the ventricle or involved in the midbrain were significantly correlated. Spearman
rank correlation analysis indicated that age was not significantly related with DOC
while bleeding stages and average CT values were weakly correlated with DOC
differences of shape and heterogeneity of density were moderately correlated with DOC
and bleeding volume and greatest hemorrhage diameter were highly correlated with DOC. Ordinal multinomial logistic regression analysis showed that: ① The greater bleeding volume or the greatest hemorrhage diameters of the hematoma are
the more serious DOC in PBH patients is. ② The probability of aggravating the DOC level in patients with
>
5~10 mL brainstem bleeding was 8.05 times higher than that in patients with ≤2 mL bleeding volume. The patients with greatest hemorrhage diameters of
>
3~4 cm in hematoma had the possibility of aggravating the DOC level at least 1 grade
which was 16.66 times higher than those with ≤2 cm. ③ There were no significant correlations among DOC and the differences of shape
heterogeneity of density
whether the hemorrhage being involved in the midbrain and broken into the brain ventricle or not.
Conclusion
2
In PBH patients
bleeding volume and greatest hemorrhage diameters of hematoma are positively correlated with DOC level. Bleeding volume of brainstem bleeding of >5~10 mL or greatest hemorrhage diameter of >3~4 cm indicates the changes of DOC level.
关键词
Keywords
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