心身压力对患者脑出血量及血肿周围水肿的影响

Effect of psychophysical stress on the volume of bleeding and perihematomal edema in patients with intracerebral hemorrhage

目的探讨心身压力对患者脑出血量及血肿周围水肿的影响。方法收集2017年8月至2018年7月脑出血患者152例,按照性格类型量表分为A型性格组和对照组两组。A型性格组83例,对照组69例。记录两组患者入院后格拉斯哥昏迷评分(GCS)和血压的变化,检查血小板数、国际标准化比值(INR)等指标,记录患者高血压及糖尿病史等。检测患者在入院时及入院后3、7、14d的CT检查并记录脑出血量和血肿周围水肿(PHE),同时行血管紧张素Ⅱ(ATⅡ)检查。结果 A型性格组有高血压病史人数明显高于对照组,两组比较差异有统计学意义(P<0.05)。A型性格组生活事件中负性生活事件明显高与对照组,两组比较差异有统计学意义(P<0.01)。A型性格组患者入院时ADL明显低于对照组,两组比较差异有统计学意义(P<0.05)。A型性格组患者入院时脑出血量、入院3d时PHE及入院、3d和14d时血浆ATⅡ均明显多于对照组,两组比较差异均有统计学意义(P<0.05或0.01)。结论心身压力增加及ATⅡ的分泌增高可能是导致患者脑出血量增多和水肿加重的原因之一。

Objective To investigate the effect of psychophysical stress on the volume of bleeding and perihematomal edem(PHE) in patients with intracerebral hemorrhage. Methods One hundred and fifty-two patients with cerebral hemorrhage admitted from August 2017 to July 2018 were enrolled, including 104 males and 48 females. Patients were classified into A type personality(A type group) and non-A type personality(control group) according to the personality type scale. Patients underwent CT examination at 3 d, 7 d and 14 d after admission and the volume of cerebral hemorrhage and PHE were recorded;and the plasma angiotensin Ⅱ(ATⅡ) level was measured at the above time points. After admission, the GCS score and blood pressure were examined, the number of platelets and the international standardized ratio were determined, and the history of hypertension and diabetes was documented. Results The proportion of patients with a history of hypertension in A type group was significantly higher than that of control group(P<0.05). There were no significant differences in gender, age, and history of smoking,drinking and diabetes between the two groups(all P >0.05). The negative life events were significantly higher in A type group than those in control group(P<0.01). At the time of admission, the volume of cerebral hemorrhage was significantly higher in A type group than that in control group(P<0.05);the severity of PHE reached the peak at 3 d and 7 d after admission, and there was a significant difference between the two groups at 3 d(P<0.05). The plasma ATⅡ gradually increased within 7 d after hemorrhage,and there was a significant difference between the two groups at 3 d and 14 d after admission(P<0.05). At the time of admission,the ADL score was significantly lower in A type group than that in control group(P<0.05), and there was no significant difference between the two groups at the time of discharge. Conclusion The psychophysical stress and high secretion of ATⅡ may be the causes of increased volume of bleeding with severity of PHE in patients with intracerebral hemorrhage.