同时发生的多发性脑出血:临床特征、危险因素和转归  

Simultaneous multiple intracerebral hemorrhages: clinical features, risk factors, and outcomes

作　　者：郝璞珩 陈斌[2] 贺世明[1] 李娜 Hao Puheng;Chen Bin;He Shiming;Li Na(Department of Neurosurgery, Xi'an International Medical Center, Xi'an 710100, China;Department of Neurosurgery, the First Affiliated Hospital of Xi'an Medical University, Xi'an 710077, China;Department of Rehabilitation Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China)

机构地区：[1]西安国际医学中心医院神经外科,710100 [2]西安医学院第一附属医院神经外科,710077 [3]西安交通大学第一附属医院康复医学科,710061

出　　处：《国际脑血管病杂志》2019年第6期426-432,共7页International Journal of Cerebrovascular Diseases

基　　金：陕西省自然科学基金青年项目(2017JQ8033).

摘　　要：目的探讨同时发生的多发性脑出血(simultaneous multiple intracerebral hemorrhage, SMICH)的临床特征、危险因素和转归。方法回顾性分析西安医学院第一附属医院神经外科2007年1月1日至2016年12月31日期间连续入院的急性自发性脑出血(intracerebral hemorrhage, ICH)患者,收集患者人口统计学、病史、临床资料以及影像学特征。SMICH定义为首次颅脑CT提示同时出现的非同一部位的ICH,含2个或以上病灶。在出院3个月后采用改良Rankin量表评定患者转归,0~2分定义为转归良好,>2分定义为转归不良。应用多变量logistic回归分析确定转归不良和死亡的独立危险因素。结果研究期间共纳入962例ICH患者,其中69例(7.2%)为SMICH。在SMICH患者中,25例(36.2%)转归良好,44例(63.8%)转归不良;死亡42例,病死率高达60.9%。多变量logistic回归分析显示,口服抗凝药[优势比(odds ratio, OR) 6.312,95%可信区间(confidence interval, CI) 1.967~9.258]、ICH病因分型(OR 9.671,95% CI 2.315~12.567)、血肿部位(OR 1.269,95% CI 1.018~2.112)和低基线GCS评分(OR 3.267,95% CI 1.159~5.627)是SMICH的独立危险因素;年龄(OR 4.156,95% CI 2.315~5.669)、血肿部位(OR 1.231,95% CI 1.018~1.972)、血肿破入脑室(OR 1.125,95% CI 1.007~2.132)和低基线GCS评分(OR 1.336,95% CI 1.005~2.079)是SMICH患者转归不良的独立危险因素;年龄(OR 5.267,95% CI 1.976~7.228)、血肿破入脑室(OR 1.726,95% CI 1.011~2.236)和低基线GCS评分(OR 2.111,95% CI 1.236~3.671)是SMICH患者死亡的独立危险因素。结论SMICH是一种少见的脑血管病,转归较差,病死率极高。口服抗凝药、ICH病因分型、血肿部位和低基线GCS评分是SMICH的独立危险因素,高龄、血肿部位、血肿破入脑室和低基线GCS评分是SMICH患者转归不良的独立危险因素,高龄、血肿破入脑室和低基线GCS评分是SMICH患者死亡的独立危险因素。Objective To investigate the clinical features, risk factors, and outcomes of simultaneous multiple intracerebral hemorrhage (SMICH). Methods Consecutive patients with acute intracerebral hemorrhage (ICH) admitted to the Department of Neurosurgery, the First Affiliated Hospital of Xi'an Medical University from January 1, 2007 to December 31, 2016 were analyzed retrospectively. The demographics, medical history, clinical data, and imaging features of the patients were collected. SMICH was defined as ICH with two or more lesions at different parts of the brain at the same time on the first brain CT scan. Three months after discharge, patients were assessed by the modified Rankin Scale scores, 0-2 was defined as good outcome, and >2 was defined as poor outcome. Multivariate logistic regression analysis was used to determine the independent risk factors for poor outcomes and death. Results A total of 962 patients with ICH were enrolled during the study, 69 of them (7.2%) were SMICH. Among the patients with SMICH, 25 (36.2%) had a good outcome, 44 (63.8%) had a poor outcome, and 42 died, with a mortality rate of 60.9%. Multivariate logistic regression analysis showed that oral anticoagulants (odds ratio [OR] 6.312, 95% confidence interval [CI] 1.967-9.258), ICH etiology classification (OR 9.671, 95% CI 2.315-12.567), hematoma site (OR 1.269, 95% CI 1.018-2.112), and low baseline GCS score (OR 3.267, 95% CI 1.159-5.627) were the independent risk factors for SMICH;age (OR 4.156, 95% CI 2.315-5.669), hematoma site (OR 1.231, 95% CI 1.018-1.972), hematoma broke into the ventricle (OR 1.125, 95% CI 1.007-2.132), and low baseline GCS score (OR 1.336, 95% CI 1.005-2.079) were the independent risk factors for poor outcome in patients with SMICH;age (OR 5.267, 95% CI 1.976-7.228), hematoma broke into the ventricle (OR 1.726, 95% CI 1.011-2.236) and low baseline GCS score (OR 2.111, 95% CI 1.236-3.671) were the independent risk factors for death in patients with SMICH. Conclusions SMICH is a rare cerebrovascular disease with a

关 键 词：脑出血 危险因素 治疗结果 

分 类 号：R743.34[医药卫生—神经病学与精神病学]