初步探讨急性脑出血死亡的危险因素  

Risk factors related to death in acute cerebral hemorrhage

作　　者：陈国芳[1] 李夫民[2] 朱军[2] 平蕾[1] 周生奎[1] 刘薇薇[1] 刘雷婧 张冬梅[1] 田永芳[1] 李再利[1] 陈珍[1] 王琛[3] 

机构地区：[1]徐州市中心医院神经内科,江苏省221009 [2]徐州市中心医院急诊科,江苏省221009 [3]徐州医学院,江苏省221002

出　　处：《中华临床医师杂志（电子版）》2016年第1期46-50,共5页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨急性脑出血死亡的危险因素,积极进行早期干预,降低病死率。方法 128例发病6 h的急性脑出血患者,收缩压在150~220 mm Hg之间,记录患者一周内不同时间段血压（到院急诊,入院当时,入院后24 h内每隔6 h及其后每日2次血压）,入院时及（24±3）h的CT复查血肿大小和神经功能缺损程度（GCS,NIHSS）评分,随访90 d m RS评分,分析死亡的相关因素。结果 （1）128例患者中90 d死亡11.7%,其中死亡在24 h内占6.7%,一周内达40%。（2）90 d死亡与发病年龄密切相关,死亡者与生存者平均年龄分别为（75.53±15.18）岁和（62.79±13.25）岁,有显著差异（P〈0.001）;但死亡与性别无关。（3）90 d死亡者与生存者,急诊血压分别为（181.87±18.30）mm Hg和（184.39±18.65）mm Hg（P=0.945）;入院当时血压分别为（180.33±17.17）mm Hg和（174.72±16.13）mm Hg（P=0.788）,均无关;但死亡与入院后30 min、45 min及6 h血压有显著相关（r=0.263,P=0.003）,血压越高,死亡率越高。（4）死亡与发病前后24 h的血肿体积量密切有关（P〈0.01）,与血肿部位无关。（5）将年龄、性别和入院血肿量、神经功能评分及血压进行多因素二元Logistic回归分析,发现年龄[OR：1.082,95%CI（1.018~1.149）,P=0.011]和血肿体积[OR：1.011,95%CI（1.000~1.023）,P=0.046]是死亡的独立危险因素。结论高龄和血肿体积增大是高血压脑出血死亡的重要危险因素。积极控制血肿体积,可以降低死亡率。Objective To investigate the risk factors related to death in acute intracerebral hemorrhage（ICH）. Methods Between November 2011 and July 2014, 128 patients with acute ICH within 6 hours were observed and analyzed. Blood pressure of each patient was recorded at different time points（emergency, admission, q6 h within 24 hours and twice daily after 24 hours） within one week. CT scanning was performed at emergency and the following（24±3） hours, and neurological impairment was evaluated using Glasgow Coma Scale and National institutes of health Stroke Scale. Outcomes were death, defined as a modified Rankin Scale score 6, at 90 days. Results Our study showed that at 90 days, the mortality of ICH was 11.7%（6.7% died within 24 hours, 40% within one week）, and was closely related to age（P0.001） but not gender. Significant association was detected between mortality and high blood pressure at 30 minutes, 45 minutes and 6 hours after admission（r=0.263, P=0.003）, but not at emergency and admission[（181.87±18.30） mm Hg vs.（184.39±18.65） mm Hg, P=0.945;（180.33±17.17） mm Hg vs.（174.72±16.13） mm Hg, P=0.788]. Death was also associated with hematoma volume at 24 hours but not with the location. Results from multivariate binary Logistic regression analysis showed that age OR 1.082, 95% CI 1.018-1.149, P=0.011, and hematoma volume OR 1.011, 95% CI 1.000-1.023, P=0.046. They were independent risk factors of death of ICH. Conclusion Age and hematoma volume may be important early predictors of death in ICH. Proactive control and management of hematoma may reduce the mortality of ICH.

关 键 词：脑出血 高血压 死亡 危险因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]