高血压脑出血患者早期血肿扩大的影响因素及预后研究

Influence Factors and Prognosis of Early Hematoma Enlargement in Patients with Hypertensive Intracerebral Hemorrhage

目的探讨高血压脑出血患者早期血肿扩大的影响因素及预后。方法选取重庆市黔江中心医院2015年10月—2016年10月收治的高血压脑出血患者124例,根据有无血肿扩大分为血肿扩大组45例与血肿未扩大组79例。两组患者入院后行常规治疗,符合血肿清除术指征者行血肿清除术。比较两组患者临床资料和预后。结果两组患者性别、年龄、肥胖所占比例、血糖、基底核脑出血所占比例比较,差异无统计学意义(P>0.05);两组患者饮酒史、美国国立卫生研究院卒中量表(NIHSS)评分、格拉斯哥昏迷量表(GCS)评分、出血量、血肿密度不规则、血肿形态不规则者所占比例、血压控制不平稳者所占比例比较,差异有统计学意义(P<0.05)。两组患者出院后第3个月病死率和卒中复发率比较,差异无统计学意义(P>0.05);血肿扩大组患者出院后第3、6个月格拉斯哥预后量表(GOS)评分低于血肿未扩大组,出院后第6个月病死率和卒中复发率高于血肿未扩大组(P<0.05)。结论高血压脑出血患者饮酒史、NIHSS评分、GCS评分、出血量、血肿密度不规则、血肿形态不规则、血压控制不平稳是早期血肿扩大的影响因素,血肿扩大在脑出血患者预后评估中具有重要作用,可作为患者预后的预测指标。

Objective To investigate the influence factors and prognosis of early hematoma enlargement in patients with hypertensive cerebral hemorrhage. Methods A total of 124 cases of patients with hypertensive intracerebral hemorrhage were selected from October 2015 to October 2016 in Chongqing Qianjiang Central Hospital, which were were divided into hematoma enlargement group（ n = 45） and non-hematoma enlargement group（ n = 79） according to hematoma enlargement situation. Both groups of patients were underwent conventional treatment,the patients with hematoma indications were removed of intracranial hematoma. The clinical data,follow-up results and prognosis were compared between the two groups. Results No statistically significant differences in gender,ages,obesity,blood glucose,basal ganglia hemorrhage was found between the two groups（ P 〉 0. 05）; the difference of drinking history, NIHSS score, GCS score, hemorrhage volume, irregular hematoma density,irregular hematoma,blood pressure control were statistically significant between the two groups（ P 〈 0. 05）. After treatment of 3 months,no statistically significant difference mortality rate,recurrent rate of stroke was found between the two groups（ P 〈 0. 05）; after treatment of 3,6 months,the hematoma enlargement group of GCS score,recurrent rate of stroke and mortality rate after treatment of 6 months were lower than non-hematoma enlargement group（ P 〈 0. 05）. Conclusion Drinking history, NIHSS score, GCS score, hemorrhage volume, irregular hematoma density, irregular hematoma, blood pressure control is the influence factors of early enlargement of hypertensive intracerebral patients,hematoma expansion plays an important role in the prognosis of cerebral hemorrhage patients,it can be used as a predictor of the prognosis of the patients.