神经外科手术患者预后预测指标的回顾性分析

Screening of prognostic indexes in post-neurosurgical patients

摘要:

目的 为神经外科手术患者预后提供有效的预测指标，为手术和围术期麻醉提供科学的依据，分析麻醉分级预测神经外科手术患者的预后。方法 选取2013年4～5月中南大学湘雅医院行神经外科手术505例患者，对患者的多项临床资料进行分析，包括基础资料：患者性别、年龄、病因类型、手术方式、高血压；患者术前状况评估：格拉斯哥昏迷评分（GCS评分）、麻醉分级、ASA分级、急性生理及慢性健康状况评分系统（APACHEⅡ）、手术分级；术中因素：手术持续时间、术中心血管事件有无、术中输血有无及术后发热，共计14项因素。以患者出院时格拉斯哥预后评分（GOS评分）评判预后，遴选出差异有统计学意义的变量，再应用回归分析讨论影响患者预后的影响因素。结果 ASA分级、麻醉分级及术前APACHⅡ评分与GOS评分相关（P?< 0.05）。结论 在ASA分级、麻醉分级、术前APACHEⅡ评分这3项可作为预测预后的指标，麻醉分级是最有效的预测指标。

Abstract:

Objective To screen prognostic predictors in patients undergoing general anesthesia and neurosurgery. Methods From April to May 2013, a total of 505 patients who were enrolled in Xiangya hospital were enrolled in this study. Clinical data including basic data (age, gender, etiology, procedure type, hypertension), preoperative assessments (Glasgow Coma score, Acute Physiology and Chronic Health Evaluation II score, ASA classification, anesthesia classification, grading of operation), intra- and post-operative data (operation time, intraoperative cardiac risk events, blood transfusion, and postoperative fever) were collected and analyzed. Glasgow Outcome Score (GOS) at the time of discharge were applied as manifestation of recovery. Chi-square test was used for univariate analysis, and two classification Logistic Regression were conducted to clarify the independent prognostic factors. Results Anesthesia classification, ASA grading and APACHE II score were statistically correlated with GOS outcome. Anesthesia classification exerted highest relative risk of 3.333. Conclusions The APACHE II score system, ASA grading system and anesthesia classification system may be independent prognostic markers of neurosurgical patients.