高血压性脑出血早期血肿扩大因素及预后分析

Analysis on cause and prognosis of early hematoma enlargement in hypertensive cerebral hemorrhage

目的探讨高血压性脑出血后早期血肿扩大的因素及因血肿扩大对患者预后的影响。方法对高血压性脑出血后早期血肿扩大的71例患者及无早期血肿扩大的71例患者临床资料进行回顾性分析,在治疗6个月后按格拉斯哥结果分级及日常生活活动能力对两组患者进行对比分析。结果血压稳定的患者发生早期血肿扩大明显低于血压不稳定的患者(P<0.01);丘脑部位的出血易发生早期血肿扩大(P<0.05);血肿量的大小与早期血肿扩大无明显关系;不规则形态的血肿较形态规则的血肿易发生早期血肿扩大(P<0.01);存在凝血功能异常的患者易发生早期血肿扩大。早期血肿扩大会明显增加患者的死亡率和重残率,降低患者的痊愈率,与对照组相比差异有显著统计学意义(P<0.01);ADLⅠ级明显差于对照组(P<0.01),而在ADLⅡ～Ⅴ级方面,两组之间无差异(P>0.05)。结论患者血压的稳定性、血肿的部位、血肿的形态以及患者凝血功能有无异常均与脑出血后早期血肿扩大有关。高血压性脑出血早期扩大会增加患者的病残率及死亡率。

Objective To analyze the causes of early hematoma enlargement in hypertensive cerebral hemorrhage and its effects on prognosis. Methods The clinical data of 71 cases with early hematoma enlargement after hypertensive cerebral hemorrhage and 71 cases without early hematoma enlargement were retrospective analyzed.After 6 months of treatment,treatment results were compared between two groups according to Glasgow outcome scale（GCS） and activities of daily living（ADL）. Results The occurrence of early hematoma enlargement in patients with stable blood pressure is obviously lower than patients with unstable blood pressure（P0.01）;early hematoma enlargement occurred easily in thalamic hemorrhage（P0.05）;the volume of hematoma had no significant relationship with early hematoma enlargement;early hematoma enlargement occurred easier in irregular hematoma than in regular hematoma（P0.01）;patients with coagulation abnormalities has more chance to occur early hematoma enlargement.Early hematoma enlargement can obviously increase the death rate and disability rate of patients as well as reduce the cure rate,compared with control group,the difference had statistical significance（P0.01）.Patients of the experimental group in ADL grade Ⅰ were obviously worse than the control group and there were no difference in ADL grade Ⅱ to Ⅴ between 2 groups（P0.05）. Conclusion The stability of blood pressure,occurrence site and shape of hematoma and coagulation function are related to the occurrence of early hematoma enlargement after hypertensive cerebral hemorrhage.Early hematoma enlargement after hypertensive cerebral hemorrhage can increase the death rate and disability rate of patients.