CT征象对自发性脑出血患者早期血肿扩大的评估作用研究  

Evaluation of CT signs in early hematoma expansion in patients with spontaneous intracerebral hemorrhage

作　　者：丁小红 蔡学智 王晓玲[2] DING Xiaohong;CAI Xuezhi;WANG Xiaoling(Department of Radiology,Longyou County Traditional Chinese Medicine Hospital,Quzhou 324400,China)

机构地区：[1]龙游县中医医院放射科,浙江衢州324400 [2]浙江衢化医院放射科

出　　处：《全科医学临床与教育》2022年第10期877-882,共6页Clinical Education of General Practice

摘　　要：目的探讨CT征象对自发性脑出血(sICH)患者早期血肿扩大的评估价值。方法选取sICH患者186例,根据患者是否出现血肿扩大将其分为血肿扩大组(67例)与非血肿扩大组(119例),比较两组性别、年龄、既往史、入院时格拉斯哥昏迷评分(GCS)、收缩压(SBP)、舒张压(DBP)、血小板计数(PLT)、国际标准化比值(INR)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、发病至首次CT检查时间、发病至CT复查时间、初始血肿体积、出血部位、血肿是否破入脑室及CT征象。采用多因素logistic回归分析确定sICH患者早期血肿扩大的影响因素。基于多因素回归分析结果建立预测评分模型,绘制受试者工作特征(ROC)曲线分析评分模型对sICH患者早期血肿扩大的预测价值。结果血肿扩大组入院时GCS评分低于非血肿扩大组,初始血肿体积及基底节出血、血肿破入脑室、存在岛征与混合征的占比均明显高于非血肿扩大组(t分别=-10.38、12.45,χ^(2)分别=8.45、9.02、15.94、8.42,P均<0.05)。多因素logistic回归分析结果显示,入院时GCS评分(β1)、初始血肿体积(β2)、血肿破入脑室(β4)、岛征(β5)、混合征(β6)是早期血肿扩大的影响因素(OR分别=1.55、1.76、1.90、2.23、1.58,P均<0.05)。根据多因素logistic回归分析结果构建血肿扩大的评分方程:Logit(P)=-2.903+0.44×β1+0.57×β2+0.64×β4+0.80×β5+0.45×β6,总分0~6分。评分模型预测早期血肿扩大的ROC曲线下面积为0.90(95%CI 0.83~0.96),最佳截断值为4分。结论基于CT征象的评分模型对sICH患者早期血肿扩大有较高的预测价值,有利于早期识别血肿扩大的高危人群。Objective To explore the value of CT signs in evaluating early hematoma expansion in patients with spon-taneous intracerebral hemorrhage(sICH).Methods A total of 186 patients with sICH were selected and divided into hematoma expansion group(67 cases)and non-hematoma expansion group(119 cases)according to whether the pa-tients had hematoma expansion.The gender,age,past history,glasgow coma scale(GCS)on admission,systolic blood pressure(SBP),diastolic blood pressure(DBP),platelet count(PLT),international normalized ratio(INR),and pro-thrombin time(PT),activated partial thromboplastin time(APTT),the time from the onset to the first CT examination,the time from the onset to the CT review,the initial hematoma volume,the bleeding location,whether the hematoma broke into the ventricle,and CT signs were compared between the two groups.Multivariate logistic regression analysis was used to determine the influencing factors of early hematoma expansion in patients with sICH.Based on the results of multivari-ate regression analysis,a predictive scoring model was established,and receiver operating characteristic(ROC)curves were drawn to analyze the predictive value of the scoring model for early hematoma expansion in patients with sICH.Re⁃sults The GCS score in the hematoma expansion group was lower than that in the non-hematoma expansion group,while the initial hematoma volume,the proportions of basal ganglia hemorrhage,hematoma rupture into the ventricle,island sign,and mixed sign at admission were significantly high-er than those in the non-hematoma expansion group(t=-10.38,12.45,χ^(2)=8.45,9.02,15.94,8.42,P<0.05).The results of multivariate logistic regression analysis showed that GCS score at admission(β1),initial hematoma volume(β2),hematoma ruptured into the ventricle(β4),island sign(β5),and mixed sign(β6)were the influencing factors of early hematoma expansion(OR=1.55,1.76,1.90,2.23,1.58,P<0.05).The scoring equation of hematoma expansion was constructed according to multivariate Logistic regression analysis.Log

关 键 词：自发性脑出血 血肿扩大 血肿形态 血肿密度 CT征象 预测价值 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R816.1[医药卫生—临床医学]