脑出血早期血肿扩大的危险因素分析

Risk factors for early hematoma enlargement in acute intracerebral hemorrhage patients

目的分析脑出血早期血肿扩大的危险因素。方法选择脑出血患者133例,根据是否出现血肿扩大分为血肿扩大组46例和血肿未扩大组87例,通过单因素分析和多因素分析2组间各因素的差异,确定早期血肿扩大的危险因素。结果血肿扩大组发病≤6h行头颅CT者占84.8%。与血肿未扩大组比较,血肿扩大组患者昏迷(15.2%vs 3.4%,P=0.032)、抗血小板药物应用(8.7%vs 1.1%,P=0.048)、入院24h体温升高≥1℃(26.1%vs 2.3%,P=0.000)、首次出血量[(22.15±10.72)ml vs(14.28±6.72)ml,P=0.019]显著增高。血肿扩大组与血肿未扩大组在出血部位(基底节、丘脑、脑叶)和首次头颅CT距发病时间(发病、≤3h、>3h且≤6h、>6h)比较,差异有统计学意义(P<0.05)。多因素logistic回归分析发现,入院24h内体温升高≥1℃、首次头颅CT距发病时间≤3h是脑出血早期血肿扩大的独立危险因素。结论伴有入院24h内体温升高≥1℃、首次头颅CT距发病时间≤3h危险因素的患者,应严密观察病情变化,尽早采取相关措施,降低病死率。

Objective To analyze the risk factors for early hematoma enlargement in intracerebral hemorrhage patients.Methods One hundred and thirty-three intracerebral hemorrhage patients were divided into hematoma enlargement group（n=46）and non-hematoma enlargement group（n=87）.The risk factors for early hematoma enlargement were assayed by univariate and multivariate logistic analysis.Results The patients who underwent CT at≤6hafter the onset of disease accounted for 84.8%of those with hematoma enlargement.The incidence of coma,rate of antiplatelet therapy,elevated body temperature≥1℃ within the first 24 hafter admission and the first bleeding volume were significantly higher in hematoma enlargement group than in non-hematoma enlargement group（15.2% vs 3.4%,P=0.032;8.7% vs 1.1%,P=0.048;26.1% vs2.3%,P=0.000;22.15±10.72 ml vs 14.28±6.72 ml,P=0.019）.No significant difference was found in bleeding site and time from the first CT to the onset of disease between the 2groups（P〈0.05）.Multivariate logistic regression analysis showed that elevated body temperature≥1℃within the first 24 hafter admission and the time from the first CT to the onset of disease were the independent risk factors for early hematoma enlargement in intracerebral hemorrhage patients.Conclusion Elevated body temperature≥1℃ within the first 24 hafter admission and the time from the first CT to the onset of disease≤3hare the independent risk factors for early hematoma enlargement in intracerebral hemorrhage patients.Measures should thus be taken as early as possible to reduce their mortality.