| Through the investigation of the distribution, clinical characteristics and outcomes of the neurosurgical in-patients in Sichuan Provincial People's Hospital(SCPPH), the gender, age composition ratio, disease conditions, treatments and causes of death were analyzed to explore the factors related to the prognosis of neurosurgical diseases and provide the crucial data to promote the rational prevention and improve the outcomes of the neurosurgical diseases.The medical data registration and medical recording database of in-patients in the Neurosurgery Department of SCPPH from January 1, 2015 to December 31, 2016 was collected from the medical records administration office of SCPPH. The informations were checked and supplemented from the medical recording system as to get the detailed data for each patient, including the basic information of the patient, the general physical condition at admission, the state of consciousness, the underlying disease,imaging results, surgical conditions, disease progress, and complications during hospitalization, as well as the specific causes of death. According to the information obtained, the patient's condition for a detailed score and classification were made, and the diagnosis of the disease was based on the world's "disease and related health issues of the international statistical classification," the tenth revision, that is, ICD-10 classification. The data of the patients were statistically analyzed retrospectively.The results are as follows: 1) Totally 6440 cases wer enrolled in the analysis of medical records. There were 3534 (54.88%) male and 2906 (45.12%) female, and the male to female ratio was 1.22:1. The patients' age ranged from 102 days to 97 years old,the median age was 63 years old. There were 1901 cases of cerebral vascular diseases,1508 cases of intracranial tumors, 1264 cases of craniocerebral injuries, and other lesions in 1767 cases. Totally 3667 patients received surgical treatment. The average length of hospital stay was 16.00± 17.43 days. The recovery at discharge was as follows:There were 2122 patients fully recovered, 3222 cases improved, 892 cases healed and /or deteriorated, and 204 cases died. 2) There were 204 cases of hospitalized death. The cerebrovascular disease (53.43%) and traumatic brain injury (30.8%) were the most common diseases in Department of Neurosurgery of SCPPH. And the ratio of male to female was 1.95:1. They aged 62.316 ± 17.124 years old. In WHO age segment as follows: 22 cases in young group, 64 cases in middle age group, 61 cases in the early stage of elderly and 57 cases in the elderly group. The underlying diseases and complication rate was significantly higher than that in the non-death group. The main causes of death were central respiratory failure (58.82%), cerebral hernia (23.04%),multiple organ failure (6.86%), cardiopulmonary dysfunction (2.94%), pulmonary infection (2.94%)and septic shock (1.96%). 3) In trauma death group: There were 63 cases, male 46, female 17 (2.71: 1). The middle age (28.57%) and elder (31.75%) were most common. The injury causes as follows: falls (46.03%) and traffic accidents(38.10%) wer most common. The most severe traumatic injuries (60.32%) were died much earlier (less than 3 days after admission, 52.63%). 4). The deaths in cerebrovascular diseases: 109 cases enrolled, including 53 male and 56 female (0.95: 1).Those in early stage of elder (33.94%) were most common. There were hemorrhagic stroke in 100 cases, 9 cases of ischemic. There were 11 from 23 cases in Claassen CT grade 3, 7from 21 cases in Hunt-Hess grade 3, and 34 of 77 cases in ICH score 3. Ther were 47 cases died within 3h after admission, 46 cases died between 3-24 hours,including GCS 3-5 points in 30, 25 cases respectively. The average survival of the brain stem hemorrhage was 1.9 h after admission and the basal ganglia hemorrhage survived 6.18h on average. 5) The dead cases in brain tumors: 20 cases, 9 males and 11 females(0.82: 1), and the middle aged (45.00%) were most common. There were 14 patients received operation. 6) Prognosis factors: The primary disease is closely related to the prognosis. The Logistic regression analysis shew that, the factors related to prognosis of traumatic head injuries were hypertension, diabetes, sepsis, acute renal failure, cerebral hernia. The related prognosis factors of cerebral vascular diseases were the respiratory system disease, sepsis, acute renal failure, cerebral hernia and brain surgery. And the related prognosis factors of tumor patients were the pulmonary infection, secondary epilepsy, electrolyte disorders and gastrointestinal bleeding.The conclusions of this study are as follows, 1) The male, elderly patients are admitted more common in the department of neurosurgery. The cerebrovascular disease,brain tumor, brain injury are the three top diseases in the department of neurosurgery,SCPPH. Brain injury and cerebrovascular disease are usally admitted in emergency with high mortality and disability rate. 2) The cerebrovascular disease and brain injury are the main death diseases in department of neurosurgery, but the annual mortality rate is decreasing along with the promotion of the treatments year by year. And the death patients were mainly middle and old aged men. 3) The survival time was positively correlated with the life-critical structural damage and severity. 4) The central respiratory failure and hernia are the main causes of death, followed by multiple organ dysfunction,cardiopulmonary dysfunction and pulmonary infection. Along with the active management of neurosurgical diseases, the close attention should be paid to the comprehensive prevention of complications in severe patients. 5) According to the characteristics of disease constitution, the individualized comprehensive prevention and treatment should be promoted. |
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