急诊高血压脑出血患者72小时内死亡因素分析

Analysis of the factors for accelerating death of hypertensive intracerebral hemorrhage patients within 72 hours in the emergency department

目的：对初次发病在6h内就诊于急诊明确诊断为高血压脑出血患者的临床特征进行比较分析，探讨除外再出血因素增加72 h内患者死亡率的相关因素。方法165例高血压脑出血急诊死亡病例根据死亡时间在72 h以内或以外分成两组，比较两组基本特征（年龄、性别、BMI、糖尿病史、吸烟史、饮酒史、高脂血症史、服用抗凝药史）、临床特征（体温、卒中相关肺炎发生率、初始血浆渗透压、随机血糖、治疗1 h后收缩压、凝血功能）和Hemphill 脑出血评分。结果INR（P＝0．027）和治疗1 h后收缩压增高（P＜0．01）以及GCS评分降低（P＝0．011）是促进患者72 h内死亡的重要因素。年龄（P＜0．01）、肥胖（P＝0．010）、酗酒（P＜0．01）、体温（P＝0．036）、初始血浆渗透压（P＜0．01）、血肿≥30 mL（P＜0．01）或来源于幕下（P＝0．025）、Hemphill脑出血评分（P＜0．01）与增加72 h内患者死亡率有一定关系。结论急诊医师在诊治高血压脑出血患者时应注重体温、血压、初始血浆渗透压的干预，评估患者病情和预后时应注重Hemphill评分（年龄、GCS评分、血肿≥30 mL、血肿来源于幕下）、肥胖、酗酒、凝血功能等指标，以积极治疗，合理利用医疗资源，指导良好的医患沟通，提高治疗的成本效益。

Objective The purpose of this study was to analyze the clinical features of the deaths of hypertensive cerebral hemorrhage patients in the emergency room who were the first time to confirm the diagnosis within 6 hours from the onset and to discuss the factors for accelerating death . Methods According the time of death , 165 cases of hypertensive intracerebral hemorrhage patients was divided into two groups, one was dead within 72 hours, one was after.The basic characteristics of the two groups （ age, gender, BMI, diabetes history, smoking history, drinking history, history of hyperlipidemia , taking anticoagulants history ） , clinical characteristics （ temperature , plasma osmolality , random blood glucose , systolic blood pressure after one hour treatment , coagulation ） and Hemphill score are compared.Results INR（P=0.027） and systolic blood pressure after one hour treatment （P〈0.01）and GCS score （P=0.011）were important factors to accelerate death.Age（P〈0.01）, BMI （P=0.010）, alcoholism（P〈0.01）, body temperature（P=0.036）, plasma osmolality（P〈0.01）, hemorrhage≥30 mL （P〈0.01）and infratentorial ICH origin（P=0.025）, Hemphill score（P〈0.01） were related with the rapid death within 72 hours.Conclusion Body temperature, blood pressure, plasma osmolality should be controlled and Hemphill score （ age, GCS score, hemorrhage≥30 ml and infratentorial ICH origin）, obesity, alcoholism, and coagulation should be accessed by the emergency physicians when treating the hypertensive cerebral hemorrhage patients , in order to ensure a positive and reasonable treatment , rational use of medical resources , while guide to good communication , and improve the cost-effectiveness of treatment .