首诊CTA点征对原发性脑出血患者血肿扩大、院内死亡及不良预后的预测  

Prediction value of spot sign of CTA for hematoma expansion, inhospital mortality and poor outcome in spontaneous intracerebral hemorrhage

作　　者：林发牧[1] 许小兵[1] 谢国强 骆实 汪翔 LIN Famu;XU Xiaobing;XIE Guoqiang;LUO Shi;WANG Xiang(Department of Neurosurgery,Shunde Hospital,Nanfang Medical University,Foshan 528300,China)

机构地区：[1]南方医科大学顺德医院神经外科,广东佛山528300 [2]陕西省核工业215医院神经外科,陕西咸阳712000

出　　处：《中国医药科学》2017年第13期181-185,共5页China Medicine And Pharmacy

摘　　要：目的探讨CTA点征数量、最长轴线尺寸及CT值与脑出血患者脑血肿、院内死亡及不良预后的关系。方法对2015年12月~2016年12月本院收治脑出血患者6小时内行脑部CT扫描与CTA检查,并在发病24小时后行CT扫描,确定50名血肿扩大与50名血肿未扩大患者,比较患者一般情况、CT点征及血肿容量与血肿扩大、院内死亡及不良预后的差别,进一步多因素分析CT点征数量、最长轴线尺寸及CT值与血肿扩大、院内死亡及不良预后的关系。结果单因素分析中,脑血肿容量、首诊CT点征阳性、点征个数、最大轴线尺寸以及CT值与脑血肿扩大有关(P<0.05)。脑血肿容量、首诊CT点征阳性、点征个数与脑出血病人死亡与不良预后有关(P<0.05)。多因素分析显示,CT点征最大轴线尺寸(OR=3.497,P=0.007,95%CI:1.411~8.663)和CT值(OR=1.113,P=0.005,95%CI:1.033~1.198)为脑血肿扩大的危险因素。血肿容量(OR=1.069,P=0.013,95%CI:1.014~1.126)和CT点征个数(OR=15.868,P=0.009,95%CI:1.965~128.140)为脑出血病人死亡的危险因素。血肿容量(OR=1.058,P=0.016,95%CI:1.010~1.108)和CT点征个数(OR=4.729,P=0.045,95%CI:1.035~21.608)为脑出血病人死亡的危险因素。结论 CT点征最长轴向尺寸和CT值可预测脑血肿扩大的风险,血肿容量和CT点征个数可预测脑出血院内死亡及不良预后的风险。Objective To explore association between characteristics of spot sign and hematoma expansion,inhospitalmortality and poor outcome in spontaneous intracerebral hemorrhage.Methods CT scans and CTA wereperformed on patients with spontaneous intracerebral hemorrhage between December2015and December2016onadmission,and another CT scan was performed24hours after onset to determine hematoma expansion.50patientswith hematoma expansion and50without were finally included in our study.Univariate analyses and multivariateanalysis were performed to determine the risk factors of hematoma expansion,in-hospital mortality and poor outcome.Results In the single factor analysis,the volume of brain hematoma,the positive number of CT points,the number ofdots,the maximum axis size and the CT value were related to the enlargement of hematoma(P<0.05).The volumeof brain hematoma,the positive number of CT points and the number of dots were related to the mortality and adverseprognosis of patients with cerebral hemorrhage(P<0.05).Multivariate analysis showed that the maximum axis size(OR=3.497,P=0.007,95%CI:1.411-8.663)and CT(OR=1.113,P=0.005,95%CI:1.033-1.198)of CT points were riskfactors for enlargement of brain hematoma.The volume of hematoma(OR=1.069,P=0.013,95%CI:1.014-1.126)andthe number of CT points(OR=15.868,P=0.009,95%CI:1.965-128.140)were risk factors for mortality in patientswith cerebral hemorrhage.The volume of hematoma(OR=1.058,P=0.016,95%CI:1.010-1.108)and the number of CTpoints(OR=4.729,P=0.045,95%CI:1.035-21.608)were risk factors for mortality in patients with cerebral hemorrhage.Conclusions The CT sign,the longest axis dimension and the CT value can predict the risk of enlargement of thebrain hematoma.The volume of hematoma and the number of CT points can predict the risk of in-hospital death andadverse prognosis in cerebral hemorrhage.

关 键 词：原发性脑出血 CT点征 血肿扩大 院内死亡 不良预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学]