脉压及脉压指数与自发性脑出血早期血肿扩大的关系

The relationship between pulse pressure,pulse pressure index and early hematoma enlargement inspontaneous intracerebral hemorrhage

目的探讨脉压(PP)及脉压指数(PPI)与自发性脑出血早期血肿扩大的关系。方法记录同期入院的428例自发性脑出血患者的脉压、脉压指数,根据是否存在早期血肿扩大分为血肿扩大组与血肿稳定组,对两组数据进行统计学分析。结果(1)116例发生早期血肿扩大,PP在血肿扩大组与血肿稳定组分别为(84.81±17.36)mmHg和(67.06±16.86)mmHg;PPI在两组分别为(0.45±0.07)和(0.39±0.68)。血肿扩大组PP、PPI均高于血肿稳定组,其差异有统计学意义(P<0.05)。(2)随着PP水平的升高、PPI的增大,早期血肿扩大发生率均呈增加趋势(趋势χ2检验P<0.05)。(3)ROC曲线分析:ROC曲线下面积,PP为0.779(95%CI 0.730~0.827),PPI为0.726(95%CI 0.671~0.780);PP预测血肿扩大的最佳界值为70 mmHg,灵敏度0.80,特异度0.72;PPI预测血肿扩大的最佳界值为0.43,灵敏度0.64,特异度0.73。PP与PPI曲线下面积差异无统计学意义(P>0.05)。结论脉压与脉压指数均与自发性脑出血早期血肿扩大有关,为早期血肿扩大的危险因素,脉压预测血肿扩大的准确性与脉压指数相当。

Objective To investigate the association between pulse pressure,pulse pressure index and early hematoma enlargement in spontaneous intracerebral hemorrhage(ICH).Methods The pulse pressure and pulse pressure index of 428 patients with ICH was recorded.All patients were divided into growing hematoma group and stable hematoma group according to the existence of early hematoma enlargement and comparatively studied.Results(1)One hundred and sixteen cases showed hematoma enlargement.The PP level was(84.81±17.36)mmHg in growing hematoma group and(67.06±16.86)mmHg in stable hematoma group.The PPI level was(0.45±0.07)in growing hematoma group and(0.39±0.68)in stable hematoma group.The PP and PPI levels of the growing hematoma group were significantly higher than those of the stable hematoma group(both P<0.05).(2)The prevalence of early hematoma enlargement increased along with the increase of PP and PPI(both P<0.05).(3)Receiver operating characteristic(ROC)curve analysis showed that the areas of PP and PPI under ROC curve was 0.779(95%CI 0.730~0.827)and 0.726(95%CI 0.671~0.780).The best cutiff value for predicting the prevalence of hematoma enlargement of PP level was 70 mmHg.The sensitivity was 0.80 and the specificity was 0.72.The best cutiff value of PPI level was 0.43.The sensitivity was 0.64 and the specificity was 0.73.There was no significant difference between the area of PP and PPI under ROC curve(P>0.05).Conclusion As risk factors of early hematoma enlargement,PP and PPI are associated with the prevalence of early hematoma enlargement in ICH.PP is the same as PPI in predicting the prevalence of hematoma enlargement.