脑出血24小时内血肿扩大的预测因素  

Predictors of cerebral hematoma growth with CT blend signs

作　　者：李云飞[1] 汪银洲[1] 李永坤[1] 林守华[1] 温巧梅 LI Yun-fei;WANG Yin-zhou;LI Yong-kun;LIN Shou-hua;WEN Qiao-mei(Department of neurology..Fujian Provincial Hospital,Fuzhou 350001,China)

机构地区：[1]福建省立医院神经内科,福州350001

出　　处：《创伤与急诊电子杂志》2016年第4期204-208,共5页Journal of Trauma and Emergency(Electronic Version)

基　　金：福建省卫计委医学创新课题(2014-CX-1)

摘　　要：目的观察分析24小时内原发性脑出血患者血肿扩大的发生率并分析其可能的预测因素。方法回顾性分析2013年1月至2016年5月，在本院急诊就诊且发病在24小时内的52例原发性脑出血患者的资料，按照起病24小时内血肿体积是否增大（超过33%或增大≥12.5ml），分为血肿扩大组和非血肿扩大组。比较两组在性别、年龄、就诊时间、血肿体积、血肿位置、破入脑室、中线移位、肾功能不全、随机血糖大于8mmol/L、血凝异常、发病时收缩压、CT混合征等变量的差异，分析24小时内原发性脑出血患者发生血肿扩大的可能危险因素。结果起病24小时内的原发性脑出血患者共52例，发生血肿扩大患者15例，发生率为28.8%。与血肿未进展患者比较，单变量分析显示血肿进展患者就诊时血压高、血肿体积大、中线移位、破入脑室及CT混合征阳性的比率均显著增高(P<0.05)。进行多因素Logistic回归模型多因素分析显示：血肿体积（OR：0.058；95%CI：0.004～0.853；P=0.036）、CT混合征(OR：7.280；95%CI：1.411～37.566；P=0.016)和破入脑室（OR：7.169；95%CI：1.177～43.674；P=0.033)是血肿扩大的独立危险因素。结论对初诊24小时内自发性脑出血患者，血肿扩大发生率高达28.8%，尤其血肿大（≥25ml），破入脑室患者，若具备CT混合征，可作为再出血高危患者联合神经外科医师加强严密观察。Objective To investigate the incidence and predictors of hematoma growth incases of spontaneous intracerebral hemorrhage(ICH) within 24 hours of the onset of symptoms.Methods Fifty-two consecutive patients with spontaneous ICH admitted to Fujian EmergencyCenter from January 2013 to May 2016 were included. The data were retrospectively analyzed.In terms of the growth in hematoma volume (more than 33% or increase by ≥ 12.5 ml)within24 hours of the onset of symptoms, the patients were divided into hematoma growth group andnon-hematoma growth group. Differences in variables of gender, age, visit time, hematomavolume, location of hematoma, hemorrhage breaking into ventricles, midline shift, renalinsufficiency, random blood glucose greater than 8mmol/L, blood clotting abnormalities, systolicblood pressure at onset, blend signs between two groups were compared to analyze the possiblerisk factors. Results Of the 52 patients with ICH, 15 patients (28.8%) had hematoma growth.Compared with non-hematoma growth group, univariate analysis showed that rates of highblood pressure at onset, a large volume of hematoma, midline shift, hemorrhage breaking intoventricles and CT blend signs significantly increased in hematoma growth group (P <0.05).Multivariate analysis showed that hematoma volume (OR, 0.058; 95%CI: 0.004 ?? 0.853;P=0.036), CT blend signs (OR, 7.280; 95%CI: 1.411 ?? 37.566;P=0.016 ) and hemorrhage breaking into ventricles (OR, 7.169; 95%CI: 1.177 ?? 43.674; P=0.033) were independent riskfactors for hematoma growth. Conclusion Hematoma growth rate of spontaneous ICH within24 hours of the onset of symptoms is as high as 28.8%. Those with large hematoma ( ≥ 25ml),hemorrhage breaking into ventricles and CT blend signs should be closely observed by bothneurologists and neurosurgeons.

关 键 词：脑出血 预测 血肿 

分 类 号：R743.34[医药卫生—神经病学与精神病学]