进展性高血压性脑出血发生时间及危险因素分析

The Occurring Time and Risk Factors of Progressive Hypertensive Intracerebral Hemorrhage.

目的探讨进展性高血压脑出血(PHICH)发生时间及其危险因素,为及时判断PHICH提供线索。方法通过CT检查比较高血压脑出血病程中前后血肿量,分析患者年龄、性别、血肿部位、凝血异常及第1次头颅CT检查距发病时间等因素对PHICH发生的影响。结果143例高血压脑出血患者中41例(28·7%)出现PHICH,其中32例(22·4%)因血肿量大需急诊开颅手术。PHICH多于发病24小时内发生,高龄、丘脑出血、持续血压升高、凝血机制异常及第1次CT距发病时间短者PHICH发生率高。结论PHICH发生率占高血压脑出血的1/4,对高龄、丘脑出血、持续收缩压升高、凝血机制异常及第1次CT距发病时间短者应加强观察,并于起病后24小时内及时复查CT。

Purpose Progressive hypertensive intracerebral hemorrhage （PHICH） is often observed in clinical ward, but its prognosis is undetermined. This study is to investigate the duration and the risk factors of progressive hypertensive intmcerebral hemorrhage. Methods The diagnusis of PHICH was determined by comparing the first and second CT scans. Potential risk factors including the sex, age, location of hematoma, blood pressure, coagulopathy and the duration of admission to the first CT scan were analyzed. Results In a cohort 143 patients, the PHICH were found in 41 cases （28.7%） after the second scan, and among them, 32 patients （22.4%） were necessary to perform craniotomy for evacuation of hematoma, most of the PHICH occurred within 24 hours after onset.Older age, thalamus bleeding, high systolic blood pressure within 6 hours, coagulapathy and shorter duration from admission to the first CT scan were the predictors associated with PHICH. Conclusion PHICH occurs in almost 1/4 of hypertensive intracerehral hemorrhage, predominantly in elder, thalamus hleeding, coagulapathy, high systolic blood pressure within 6 hours and shorter duration between onset and the first CT scan. CT examination within 24 hours after admission is crucial to reveal the exact condition of the patient.