幕上高血压脑出血早期血肿扩大的相关因素和预后分析

An analysis of the factors related to hematoma enlargement in the early stage of supratentorial hypertensive intracerebral hemorrhage and its prognosis

目的探讨幕上高血压脑出血早期血肿扩大的相关因素和预后。方法回顾性分析徐州医科大学附属医院神经外科2015年01月至2019年05月诊断为幕上高血压脑出血并入院时行保守治疗患者的临床资料,其中符合第四届全国脑血管病会议制定的诊断标准且有完整临床数据的患者共346人。按准入及排除标准,将其分为血肿扩大组(101人)及血肿未扩大组(245人),分析患者性别、年龄、血型、是否有糖尿病史、血肿部位、血肿形态、血肿量、入院时格拉斯哥昏迷评分(GCS)、首次头颅CT距离发病时间、入院时红细胞分布宽度(RDW)、血红蛋白(HB)、血小板(PLT)、白细胞(WBC)、中心粒细胞(ANC)、淋巴细胞(ALC)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、白蛋白(ALB)、肌酐(CREA)、血糖值(GLU)、血清钙(CA)、血清镁(Mg)、总胆固醇(CHOL)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、凝血功能(PT、APTT、FIB)、入院血压(SBP、DBP)等相关指标。根据患者发病后6个月的格拉斯哥预后分级来评估患者预后情况。结果单因素分析显示血肿扩大组患者性别、血型、血肿形态、血肿量、首次CT距离发病时间、入院时格拉斯哥昏迷评分、血糖、低密度脂蛋白与血肿未扩大组之间差异有统计学意义(P<0.05),进一步多因素Logistic回归分析显示患者性别、血型、血肿形态、首次CT距离发病时间、入院时格拉斯哥昏迷评分、血糖、低密度脂蛋白在两组患者之间差异有统计学意义(P<0.05)。预后结果显示血肿扩大组的患者死亡率和致残率明显高于血肿未扩大组患者。结论患者性别、血型、血肿形态、首次CT距离发病时间、入院时格拉斯哥昏迷评分、血糖、低密度脂蛋白是幕上高血压脑出血早期血肿扩大的独立影响因素。发生血肿扩大的患者预后更差。

Objective To explore the factors related to hematoma enlargement in the early stage of supratentorial hypertensive intracerebral hemorrhage(SHICH)and its prognosis.Methods A retrospective analysis was conducted on the clinical data of patients who were diagnosed with SHICH in the Neurosurgery Department of the Affiliated Hospital of Xuzhou Medical University from January 2015 to May 2019 and received conservative treatment on admission.Among the patients,346 met the diagnostic criteria established at the Fourth National Conference on Cerebrovascular Diseases in China and had complete clinical data.According to the inclusion and exclusion criteria,the patients were divided into hematoma enlarged group(HE group,101 cases)and hematoma unenlarged group(HUE group,245 cases).The patients were analyzed for relevant indices such as sex,age,blood type,diabetes history,hematoma location,hematoma morphology,hematoma volume,Glasgow Coma Scale(GCS)on admission,time to disease onset since initial head CT examination,and red cell distribution width,hemoglobin,platelet,white blood cell count,absolute neutrophil count,absolute lymphocyte count,alanine aminotransferase,aspartate aminotransferase,albumin,creatinine,blood glucose(GLU),serum calcium,serum magnesium,total cholesterol,triglyceride,low-density lipoprotein(LDL),high-density lipoprotein,coagulation function(PT,APTT,and FIB),and blood pressures(SBP and DBP)on admission.The prognoses of the patients were evaluated according to the Glasgow Outcome Scale at 6 months after disease onset.Results An univariate analysis showed that there were significant differences between the two groups in sex,blood type,hematoma morphology,hematoma volume,time to disease onset since initial head CT examination,GCS on admission,GLU,and LDL(P<0.05);differences in these indices(except hematoma volume)between the two groups were also significant in a further multivariate logistic regression analysis(P<0.05).The results of the prognostic analysis showed that the mortality and disability rates of patients in the HE group were significantly higher than those in the HUE group.Conclusions Sex,blood type,hematoma morphology,time to disease onset since initial head CT examination,GCS on admission,GLU,and LDL are independent factors influencing hematoma enlargement in the early stage of SHICH.Patients with the hematoma enlargement have worse prognoses.