Abstract: Objective  To investigate the outcome on 90 d and influencing factors for the outcome in conscious patients with intracerebral hemorrhage (ICH).  Methods Two hundred and twenty-five patients with ICH were admitted to our hospital within 6 h after onset and were suitable to be treated with medical conservative therapy. Patients were divided into two groups, the conscious group [Glasgow Coma Scale (GCS) score ≥ 9] and the coma group (GCS score ≤ 8). Clinical features including gender, age, National Institute of Health Stroke Scale (NIHSS) score, etc, were recorded. The prognosis of these patients on 90 d after onset was evaluated by the following index: survival or death; favorable prognosis [modified Rankin Scale (mRS) score ≤ 2] or unfavorable prognosis (mRS score ≥ 3, death or severe disability). The difference of clinical features and prognosis between the conscious group and coma group was explored. The prognosis of the patients in conscious group was analyzed, and influencing factors for prognosis were explored.  Results  Multifactorial Logistic regression analysis indicated that hyperglycemia, higher NIHSS score, rehemorrhagia and hematemesis were independent risk factors for 90-day mortality. On the other hand, advanced age, higher NIHSS score, rehemorrhagia and hematemesis were independent risk factors for death or severe disability on 90-day. Conclusion  In ICH patients who were conscious on admission, hyperglycemia, advanced age, higher NIHSS score, rehemorrhagia and hematemesis are strong predictors for mortality and unfavourable outcome. Controlling hyperglycemia and prevention of rehemorrhagia and hematemesis are important elements for reducing 90-day mortality and severe disability.

Key words: Cerebral hemorrhage, Glasgow Coma Scale, Prognosis, Regression analysis

摘要： 目的 探讨入院时意识清醒的自发性脑出血患者发病90 d 时预后及其相关影响因素。方法 选择发病6 h 内入院且适宜内科保守治疗的225 例自发性脑出血患者，记录性别、年龄、美国国立卫生研究院卒中量表（NIHSS）评分等临床特征，以发病90 d 时生存或死亡、预后良好［改良Rankin 量表（mRS）评分≤ 2 分］或预后不良（mRS 评分≥ 3 分，包括死亡或重残）为结局判断终点，多因素Logistic 回归分析探讨影响意识清醒脑出血患者预后的相关因素。结果 多因素Logistic 回归分析显示，入院时血糖水平、NIHSS 评分、再出血及呕血为发病90 d 时影响患者生存或死亡的独立危险因素；而年龄、NIHSS评分、再出血、呕血则为影响发病90 d时预后良好或预后不良的独立危险因素。结论 高血糖、高龄、高NIHSS 评分、再出血、呕血为意识清醒脑出血患者发病90 d 时死亡及预后不良的重要预测因素；控制患者入院时血糖水平、防止再出血、预防应激性溃疡，是减少发病90 d时死亡及预后不良的重要环节。

关键词: 脑出血, 格拉斯哥昏迷量表, 预后, 回归分析