自发性脑出血早期血肿扩大及相关因素分析

Early hematoma enlargement in patients with spontaneous intracerebral hemorrhage and related factors analysis

目的 探讨自发性脑出血患者发生早期血肿扩大的相关因素.方法 回顾性分析142例自发性脑出血患者的临床资料,患者均在发病6h内进行首次头颅CT检查,复查时间为发病后24 h.对自发性脑出血早期血肿扩大的危险因素进行单因素分析和多因素Logistic回归分析.结果 自发性脑出血早期血肿扩大发生率为24.6％（35/142）.多因素Logistic回归分析显示早期血肿扩大主要与年龄（OR=1.069,P=0.003）、收缩压（OR=1.865,P=0.026）、血肿形态（OR=2.712,P=0.028）、甘露醇的使用（OR=2.939,P=0.020）相关,而与血肿部位、血肿体积等因素无明显相关（P＞0.05）.结论 自发性脑出血早期血肿扩大主要与年龄、收缩压、血肿形态、甘露醇使用相关.对就诊时间较早的高龄患者及血肿形态不规则、收缩压高的患者,应注意复查CT,观察血肿变化,谨慎使用甘露醇.

Objective To explore the related factors of early hematoma enlargement in patients with spontaneous intracerebral hemorrhage.Methods The clinical data of 142 patients with spontaneous intracerebral hemorrhage were analyzed.The first CT was performed within 6 h of onset and the second within 24 h of onset.Single factor analysis and multiple Logistic regression analysis were performed to determine the related factors of early hematoma enlargement.Results The incidence of early hematoma enlargement was 24.6％ （35/142）.Multiple Logistic regression analysis revealed that the following four factors were independently associated with early hematoma enlargement：age （OR =1.069,P =0.003）,systolic pressure （OR =1.865,P =0.026）,sharp of hematoma （OR =2.712,P =0.028）,using mannitol （OR =2.939,P =0.020）.Location of hemorrhage and volume of hemorrhage were not associated with early hematoma enlargement （P ＞ 0.05）.Conclusions Age,systolic pressure,sharp of hematoma and using mannitol are the important predictors of early hematoma enlargement with spontaneous intracerebral hemorrhage.In patients with older age,higher systolic pressure,irregularly shaped hematoma,close observation of hematoma enlargement should be made CT-scanning check.And the caution in the early use of dehydrating agent should be careful.