ปัจจัยที่มีผลต่อผลลัพธ์ที่ไม่ดีในผู้ป่วยที่รับการผ่าตัดผู้ป่วยโรคหลอดเลือดสมองชนิดเลือดออกชนิดสปอนเทเนียส

Peerut Sivavetpikul

doi:10.1016/hscr.v40i2.277503

Authors

Peerut Sivavetpikul Department of Surgery, Phichit Hospital

DOI:

https://doi.org/10.1016/hscr.v40i2.277503

Keywords:

Intracerebral hemorrhage, Surgery, Mortality, Morbidity, Risk factors

Abstract

Objective: To investigate prognostic factors for mortality and morbidity in patients with hemorrhagic stroke who underwent surgical treatment at Phichit Hospital.
Methods: This prognostic study was conducted as a retrospective cohort of patients aged over 18 years who underwent surgical treatment for intracerebral hemorrhage at Phichit Hospital between October 1, 2020, and May 31, 2024. Prognostic factors were analyzed using logistic regression.
Results: A total of 201 patients were included. The overall mortality rate was 29.9%. Among survivors, the morbidity rate was as high as 86.52%. Factors significantly associated with mortality included low initial level of consciousness (Glasgow Coma Scale, GCS ≤5), coagulopathy, warfarin use, comorbidities (chronic kidney disease/atrial fibrillation), and postoperative complications such as sepsis and acute kidney injury (AKI). Factors associated with morbidity included age over 60 years, hematoma volume ≥30 mL, dyslipidemia, and postoperative infections (pneumonia and urinary tract infection).
Conclusions: Early identification and close monitoring of high risk patients such as those with impaired consciousness, coagulopathy, or major comorbidities together with strict prevention of postoperative infections, are crucial strategies to reduce mortality and improve patient outcomes. These prognostic factors may also serve as valuable information for providing prognostic counseling to patients’ families before and after surgery.

References

เทียมเก่า ส. แนวโน้มการเสียชีวิตผู้ป่วยโรคหลอดเลือดสมองฉับพลัน. วารสารประสาทวิทยาแห่งประเทศไทย. 2022;39:32–38.

Zhang K, Wei L, Zhou X, Yang B, Meng J, Wang P. Risk factors for poor outcomes of spontaneous supratentorial cerebral hemorrhage after surgery. J Neurol. 2021;269(6):3015–3025.

Zeiser V, Khalaveh F, Cho A, Reinprecht A, Herta J, Rössler K, et al. Risk factors for unfavorable outcome after spontaneous intracerebral hemorrhage in elderly patients. Clin Neurol Neurosurg. 2024;240:108253.

Troberg F, Kronvall E, Hansen BM, Nilsson OG. Prediction of long-term outcome after intracerebral hemorrhage surgery. World Neurosurg. 2019;124:e96–e105.

Vespa PM, Martin N, Zuccarello M, Awad I, Hanley DF. Surgical trials in intracerebral hemorrhage. Stroke. 2013;44(Suppl 1):S79–S82.

Suwatcharangkoon S. Management of acute stroke patients with increased intracranial pressure. J Thai Stroke Soc. 2015;14(2):94–101.

Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the STICH trial: a randomised trial. Lancet. 2005;365(9457):387–397.

Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet. 2013;382(9890):397–408.

Bruno A, Akinwuntari AE, Lin C, Close B, Davis K, Baute V, et al. Simplified modified Rankin Scale questionnaire: Reproducibility over the telephone and validation with quality of life. Stroke. 2011;42(8):2276–2280.

Lowpreukmanee N. Clinical outcome of the patients treated surgically for spontaneous intracerebral hematoma at Sawanpracharak Hospital. J Med Assoc Thai. 2013;96(6):669–677.

Champawong K, Thaloengsok S, Kajai C. Prognostic factors for in-hospital mortality in spontaneous intracerebral hemorrhage. Greater Mekong Subregion Med J. 2024;4(2):47–62.