自发性脑出血后血肿增大的影响因素  

Influencing factors of hematoma enlargement after spontaneous intracerebral hemorrhage

作　　者：严孙宏[1] 吴小三[1] 

机构地区：[1]安徽医科大学第二附属医院神经内科,合肥230601

出　　处：《国际脑血管病杂志》2016年第12期1080-1084,共5页International Journal of Cerebrovascular Diseases

摘　　要：目的探讨自发性脑出血后血肿增大的影响因素。方法回顾性纳入自发性脑出血患者。收集患者人口统计学、血管危险因素和基线临床资料。血肿增大定义为48h内复查CT结果显示血肿体积较基线增大〉1/3。对血肿增大组与非血肿增大组人口统计学、血管危险因素和基线临床资料进行比较，采用多变量logistic回归分析确定血肿增大的影响因素。结果共纳入121例自发性脑出血患者，其中男性69例，女性52例，年龄24～89岁，平均（59．16±12．68）岁。合并高血压45例（37．2％），糖尿病5例（4．1％），高脂血症11例（9．1％）。48h内血肿增大30例（24．79％），发病至首次CT扫描时间（4．21±1．57）h，发病至复查CT扫描时间（34．78±6．90）h。单变量分析显示，血肿增大组饮酒患者的比例（46．7％对26．4％；χ2=4．313，P=0．038）以及收缩压[（174．53±20．02）mmHg对（160．63±19．79）mmHg；t=-3．327，P=0．001；1mmHg=0．133kPa]、空腹血糖[7．67（6．70～9．47）mmol／L对6．78（5．81～7．79）mmol／L；Z=-2．266，P=0．023]、美国国立卫生研究院卒中量表（National Institutes of Heakh StrokeScale，NIHSS）评分[10．00（8．00～12．00）分对5．00（3．00～8．00）分；Z=-5．468，P〈0．001]显著高于非血肿增大组，而低密度脂蛋白胆固醇[2．60（2．10～2．91）mmol／L对3．00（2．60～3．41）mmol／L；Z=-3．905，P〈0．001]显著低于非血肿增大组。多变量logistic回归分析显示，基线收缩压[优势比（oddsratio，OR）1．036，95％可信区间（confideate interval,Cl）1．007—1．065；P=0．014]和NIHSS评分（OR1．310，95％CI1．111～1．544；P=0．001）为血肿增大的独立危险因素，而低密度脂蛋白胆固醇（OR0．279，95％Cl0．105～0．742；P=0．011）为血肿增大的独立保护因素。结论收缩压和NIHSS评分为自发性脑出血后血肿增大的独立�Objective To investigate the influencing factors of hematoma enlargement after spontaneous intracerebral hemorrhage, Methods The patients with spontaneous intracerebral hemorrhage were enrolled retrospectively in the study. The demographics, vascular risk factors, and baseline clinical data of the patients were collected. Hematoma enlargement was defined as CT scan within 48 h showed that the increased hematoma voktrne was more than 〉1/3 of the baseline. The demographics, vascular risk factors, and baseline clinical data of the hematoma enlargement group and the non-hematoma enlargement group were compared. Multivariate logistic regression analysis was use to identify the risk factors for hematoma erdargement. Results A total of 121 patients with spontaneous intracerebral hemorrhage were enrolled, including 69 males and 52 females, their ages were 24 to 89 years （mean 59. 16 ± 12. 68）. Forty-five patients （37.2%） had combined hypertension, 5 （4. 1%） had diabetes, and 11 （9. 1%） had hyperlipoidemia. Thirty patients （24. 79%） had hematoma enlargement within 48 h. The time from ictus to the first CT scan was 4. 21 ± 1.57 h and the time from ictus to cr scan again was 34. 78 ~6. 90 h. Univariate analysis showed that the proportion of patients drinking alcohol （46. 7% vs. 26. 4%; X2 =4. 313, P =0. 038）, as well as systolic blood pressure （174. 53 ±20. 02 mmHg vs. 160. 63±19. 79 mmHg, t = -3. 327, P = 0. 001; 1 mmHg = 0. 133 kPa）, fasting blood glucose （7. 67[6. 70- 9. 47]mmol/L vs. 6. 78[5. 81- 7. 79]mmol/L; Z= -2. 266, P=0. 023）, National Institutes of Health Stroke Scale （NIHSS） score （10. 00[8. 00-12.00] vs. 5. 00[ 3. 00-8. 00 ]; Z = -5. 468, P 〈 0. 001 ） in the hematoma enlargement group were significantly higher than those in the non-hematoma enlargement group, while low-density lipoprotein cholesterol （2. 60[ 2. 10- 2. 91 ] mmol/L vs. 3. 00[2. 60-3. 41 ] mmol/L; Z = -3. 905, P 〈0. 001） was significantly lower than that in the nonhematoma enlargement group. M

关 键 词：脑出血 血肿 血压 危险因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学]