急性自发性脑内出血并发消化道出血风险的临床研究  

Predictive Factors of Gastrointestinal Bleeding in Acute Intracerebral Hemorrhage:a Clinical Retrospective Study

作　　者：周强[1] 王之敏[1] 杨伊林[2] 王穗暖[2] 夏锡伟[2] 宣井岗[2] 彭亚[2] 邵耐远[2] 王玉兰[3] 

机构地区：[1]苏州大学附属第一医院脑外科,江苏苏州215006 [2]常州第一人民医院脑外科,江苏常州213000 [3]常州第一人民医院神经内科,江苏常州21300

出　　处：《苏州大学学报（医学版）》2005年第6期1047-1050,1053,共5页Suzhou University Journal of Medical Science

摘　　要：目的评估急性自发性脑内出血患者并发消化道出血的发生率、严重度及风险预测指标。方法对125例急性自发性脑内出血患者资料采用回顾性病例-对照研究,结果变量为消化道出血。将一系列参数行单因素分析后做多因素logistic回归分析。结果单因素分析中:年龄,GCS评分,瞳孔不等,平均动脉压,血糖,脑室出血,血肿大小,占位效应,脑积水,凝血酶时间,开颅血肿清除术与消化道出血相关。多因素logistic回归分析表明独立的风险预测指标包括GCS评分低(P<0.001),血肿≥30 ml(P=0.017),累及脑室出血(P=0.018),开颅血肿清除术(P=0.043)。结论GCS评分低,血肿大,脑室出血及手术创伤是增加急性自发性脑内出血患者并发消化道出血风险的重要因素。Objectives To evaluate the frequency, severity, predictive factors for gastrointestinal （GI） hemorrhage in patients with acute intracerebral hemorrhage. Methods One hundred and twenty five patients with acute intracerebral hemorrhage（ICH） were included in a retrospective case-control study. The occurrence of GI hemorrhage was the variable of outcome. Some clinical parameters were evaluated by univariate followed by multivariate logistic regression analysis. Results On univariate analysis, age, GCS, pupillary asymmetry, mean BP, serum glucose, intraventricular hemorrhage （IVH）, hematoma with a size, mass effect, hydrocephalus, prothrombin time and hematoma evacuation significantly correlated with GI hemorrhage. On multivariate analysis, the independent predictors of GI hemorrhage included low GCS （P〈 0. 001）, hematoma with size beyond 30 ml （P = 0. 017）, IVH（P = 0. 018） and hematoma evacuation（P = 0. 043）. Conclusion Low GCS, larger hematoma, IVH and operation wound are the important predictors for GI hemorrhage in acute ICH.

关 键 词：消化道出血 脑内出血 应激性溃疡 脑积水 血肿 

分 类 号：R651.12[医药卫生—外科学]