脑出血后继续出血的因素及预防

Risk Factors and Prevention of Hematoma Enlargement after Spontaneous Intracerebral Hemorrhage

目的探讨脑出血后继续出血的影响因素及预防措施。方法将31例继续出血患者设为继续出血组,余101例无继续出血者设为对照组,比较两组的一般因素、既往史、行为因素、临床因素以及其他相关因素。结果继续出血组男性多于对照组,发病年龄较对照组轻;既往肝病史、服用阿司匹林者及酗酒者的比例明显多于对照组;病程较对照组明显缩短;发病时收缩压水平明显高于对照组;丘脑出血及血肿形态不规则、发病后出现呕吐躁动、24 h内应用甘露醇者的比例均多于对照组。结论年龄相对较轻的男性、既往肝脏疾病,长期服用阿司匹林、长期酗酒的脑出血患者出现继续出血的几率高,在脑出血早期收缩压持续升高、出血在丘脑且血肿形态不规则,发病后出现呕吐躁动及早期应用甘露醇是继续出血的危险因素。

Objective To explore the risk factors and preventive measures of the hematoma enlargement after spontaneous intracerebral hemorrhage（ICH）.Methods The patients with spontaneous intracerebral hemorrhage were divided into hematoma enlargement group（31 cases） and control group（101 cases）.The congenital factors,past medical history,behavioral factors,clinical factors and other relevant factors were compared between the two groups.Results As compared to the control group,the hematoma enlargement group had higher rates in male patients,especially those with history of liver diseases,aspirin taking and heavy drinking;the course was shorter,the systolic blood pressure was higher;more cases were with the thalamic hemorrhage,irregular hemorrhage shapes,vomiting and restless,and needed mannitol treatment in 24 hours.Conclusion The younger male ICH patients especially with the history of liver diseases,aspirin taking and heavy drinking should have a high rate of hematoma enlargement.The risk factors include the increased systolic blood pressure in the early stage of ICH,the hemorrhage position in thalamus,irregular hemorrhage shapes,vomiting and restless after onset of ICH and early need of mannitol treatment.