超急性期不同血肿扩大速率的急性脑出血患者临床特征及预后

Clinical characteristics and prognosis of patients with acute cerebral hemorrhage with different hematoma expansion rate in hyperacute stage

目的 探讨超急性期不同血肿扩大速率的急性脑出血患者临床特征及预后。方法 选取河南科技大学第一附属医院2019年4月至2020年4月收治的76例急性脑出血患者为研究对象。根据超急性期血肿扩大速率将患者分为A组(≤4.7ml/h,n=41)和B组(>4.7ml/h,n=35),比较两组临床特征及预后情况。结果 A组入院NIHSS评分低于B组,GCS评分高于B组(P<0.05);A组基线收缩压、舒张压低于B组(P<0.05),血小板水平高于B组(P<0.05);A组基线血肿体积及血肿扩大速率低于B组(P<0.05);A组血肿扩大发生率低于B组(P<0.05),A组3个月预后不良率为31.71%,6个月预后不良率为29.27%,低于B组(57.14%、54.29,P<0.05);超急性期不同血肿扩大速率>4.7ml、血肿体积>10ml预测患者3个月预后不良的AUC值为0.637、0.660,预测患者6个月预后不良的AUC值为0.675、0.648。结论 超急性期急性脑出血血肿扩大速率>4.7ml/h患者临床症状较严重,预后较差,临床可进行早期病情监测,筛选出预后不良的高危患者,采取积极治疗,改善患者预后。

Objective To explore the clinical characteristics and prognosis of patients with acute cerebral hemorrhage with different hematoma expansion rates in the hyperacute stage.Methods The 76 patients with acute cerebral hemorrhage admitted to the First Affiliated Hospital of Henan University of Science and Technology from April 2019 to April 2020 were selected as the research objects.According to the hyperacute hematoma expansion rate, patients were divided into group A(≤4.7 ml/h, n=41 cases)and group B(>4.7 ml/h, n=35),and the clinical characteristics and prognosis of the two groups were compared.Results The NIHSS score in group A was lower than that of group B,and the GCS score was higher than that of group B(P<0.05).The baseline systolic and diastolic blood pressure of group A was lower than that of group B(P<0.05),and the platelet level was higher than that of group B(P<0.05).The baseline hematoma volume and hematoma expansion rate in group A were lower than those in group B(P<0.05).;The incidence of enlarged hematoma in group A was lower than that in group B(P<0.05),the poor prognosis rate in group A was 31.71% at 3 months, and the poor prognosis rate at 6 months was 29.27%,which was lower than that in group B(57.14%,54.29,P<0.05).Different hematoma expansion rates >4.7 ml and hematoma volumes in the hyperacute phase >10 ml predict poor prognosis of patients with AUC values of 0.637 and 0.660,and predict poor prognosis of patients with AUC values of 0.675 and 0.648.Conclusion Patients with hyperacute acute intracerebral hemorrhage hematoma enlargement rate>4.7 ml/h have severe clinical symptoms and poor prognosis.Early clinical disease monitoring can be performed to screen out high-risk patients with poor prognosis and take active treatment to improve the prognosis of patients.