原发性脑出血患者血肿吸收的影响因素

Factors affecting hematoma absorption in patients with primary intracerebral hemorrhage

目的探讨影响原发性脑出血患者血肿吸收速度的相关因素。方法回顾性分析56例(血肿体积为2.0～33.4m1)经内科保守治疗的原发性脑出血患者的临床资料,探讨影响血肿吸收速度的因素。血肿体积采用多田氏法计算,血肿吸收速度(ml/d)=(首次检查CT血肿体积-首次复查CT后血肿体积)/间隔时间。结果①血肿吸收速度为0.13～1.90 ml/d,平均(0.58±0.31)ml/d。②单因素分析显示,不同部位的血肿吸收速度不同;10 m1≤血肿体积<30 ml的吸收速度快于<10 ml和≥30 ml的血肿吸收速度。有饮酒史、高血压病史、肝功能异常、入院首次收缩压增高及合并感染,使血肿吸收速度减慢;血浆D-二聚体水平增高、使用甘露醇加快血肿吸收速度。血肿吸收速度与总胆固醇、血尿素氮水平呈负相关(r=-0.789,r=-0.586);与高密度脂蛋白呈正相关(r=0.681)。均P<0.05。③性别、年龄,糖尿病、卒中史、吸烟史,出血是否破入脑室、血肿形态,入院时意识状况,血浆纤维蛋白原水平,空腹血糖,低钠、低钾,联合使用脱水剂,入院首次舒张压增高及住院期间平均动脉压均不是血肿吸收速度的影响因素。④多元逐步回归分析显示,血肿吸收速度与血浆D-二聚体、高密度脂蛋白水平呈正相关(t=4.781,t=2.092);与胆固醇水平、入院首次收缩压升高、尿素氮水平及合并感染呈负相关(t=-3.327,t=-3.061,t=-2.700,t=-7.421)。⑤血肿吸收速度与患者入院至首次复查头部CT时的美国国立卫生院卒中量表(NIHSS)评分变化无相关性(r=0.083)。结论血浆D-二聚体含量、血清尿素氮水平、入院首次收缩压升高,血脂水平,合并感染可能是影响脑出血后血肿吸收速度的独立影响因素。

Objective To investigate the related factors affecting the hematoma absorption rate in patents with primary intracerebral hemorrhage. Methods The clinical data of 56 patients with primary intracerebral hemorrhage （hematoma volume 2.0 to 33.4 mL） treated with conservative medical therapy were analyzed retrospectively. The factors affecting the hematoma absorption rate were investigated. The hematoma volumes were calculated with Tada Formula Measurement. The hematoma absorption rate （mL/ d） = the initial hematoma volume-hematoma volume after the first CT reexamination/time interval. Results （1）The hematoma absorption rate was 0. 13 - 1.90 mL per day （mean 0. 58- 0. 31 mL per day）. （2）Univariate analysis showed that the hematoma absorption rate at the different area of the brain was various ; Absorption rate of hematoma volume between 10 mL to 30 mL was faster than that 〈 10 mL or ≥ 30 mL. The patients with history of excessive alcohol drinking, hypertension, abnormal liver function, increased systolic blood pressure on admission, and complicated with infection night slowed down the hema- toma absorption rate. The patients with increased plasma D-dimer level and administration of mannitol would increased the hematoma absorption rate. The hematoma absorption rate was negatively correlated with the levels of cholesterol and blood urea nitrogen （r = -0. 789, r = -0. 586）, and was positively correlated with the high-density lipoprotein （r =0. 681, all P 〈0. 05）. （3）Gender, age, diabetes, history of stroke,history of smoking, bleeding into the ventricle, shape of hematoma , state of consciousness on admission, plasma fibrinogen, fasting glucose, low sodium, low potassium, the diastolic blood pressure on admission, use of dehydrated agents, mean arterial blood pressure during the hospitalization were not the affecting factors for the rate of hematoma absorption. （4）Multiple stepwise regression analysis showed that the hematoma absorption rate was positively correlated with the levels of plasma D-dimer and high-density lipoprotein, and was negatively correlated with the cholesterol level, high systolic blood pressure on admission, blood urea nitrogen level and complicated with infection. （5）The hematoma absorption rate was not associated with the changes of NIHSS scores from the patients admission to the first head CT reexamination （ r = 0.083 ）. Conclusion Plasma D-dimer level, serum urea nitrogen level, the systolic blood pressure on admission, lipid level, and complicated infection may be the independent affecting factors for influence the hematoma absorption rate after intracerebral hemorrhage.