无创动态脑水肿监测在脑出血患者临床应用探讨

Clinical application of noninvasive dynamic cerebral edema monitoring in cerebral hemorrhage patients

目的探讨脑出血患者血肿吸收和周围脑水肿的发展规律及其对神经功能缺损的影响。方法选择脑出血患者29例,记录患者发病1、3、7、14d头颅CT显示的血肿体积、水肿体积,美国国立卫生研究院卒中量表(national institutes of health strok scale,NIHSS)评分及格拉斯哥昏迷评分,应用无创脑水肿监护仪床旁动态监测,并记录患者双侧大脑半球扰动系数,同时于发病后1个月记录患者改良的Rankin量表评分,分析无创脑水肿动态监测对脑出血患者病情的评估价值。结果 29例脑出血患者发病3、7、14d患侧扰动系数明显高于健侧扰动系数(10.08±1.10 vs 9.65±1.10,10.68±1.79 vs 10.27±1.77,10.83±2.08 vs 10.17±1.62,P<0.01)。Pearson相关分析显示,脑出血患者患侧扰动系数与水肿体积、NIHSS评分呈正相关(r=0.296,P=0.008;r=0.331,P=0.003)。脑出血患者NIHSS评分与水肿体积、血肿体积呈正相关(r=0.271,P=0.015;r=0.595,P=0.000)。多元logistic回归分析显示,发病3d血肿体积是影响脑出血患者预后的主要因素(OR=1.157,P=0.002)。结论无创脑水肿动态监护仪可较灵敏的反应脑水肿的动态变化。

Objective To study the effect of hematoma absorption and cerebral edema on neurological dysfunction in cerebral hemorrhage patients.Methods Twenty-nine cerebral hemorrhage patients were included in this study.Their hematoma and edema volume,NIHSS and Glasgow Coma Scale score were recorded on days 1,3,7 and 14 after cerebral hemorrhage.The agitating coefficient of bilateral cerebral hemispheres was monitored with a noninvasive brain edema monitor.The modified Rankin Rating Scale score was recorded 1 month after cerebral hemorrhage.The role of noninvasive brain edema monitoring in assessment of cerebral hemorrhage was analyzed.Results The agitating coefficient was significantly higher on the hemorrhage hemisphere than on the healthy hemisphere on days 3,7 and 14 after cerebral hemorrhage（10.08±1.10 vs 9.65±1.10,10.68±1.79 vs 10.27±1.77,10.83±2.08 vs 10.17±1.62,P〈0.01）.Pearson correlation analysis showed that the agitating coefficient on the hemorrhage hemisphere was positively related with edema volume and NIHSS score（r=0.296,P=0.008;r=0.331,P=0.003）.The NIHSS score of cerebral hemorrhage onset time was positively related with hematoma and edema volume（r=0.271,P=0.015;r=0.595,P=0.000）.Multivariate logistic regression analysis showed that hematoma volume on day 3 after cerebral hemorrhage was a major predictor for the outcome in cerebral hemorrhage patients（OR=1.157,P=0.002）.Conclusion Noninvasive brain edema monitor can show the change of cerebral edema in cerebral hemorrhage patients.