基于CT特异征象预测自发性脑出血早期血肿扩大的危险因素

Prediction of risk factors for early hematoma enlargement in spontaneous cerebral hemorrhage based on CT specific signs

目的探讨颅脑CT平扫血肿特异征象,预测脑出血早期出现血肿扩大的危险因素。方法选取本院诊断为脑出血的患者172例,使用计算机辅助测量软件测量血肿体积,将脑出血患者分为血肿扩大组(62例)和血肿未扩大组(110例),对脑出血患者的相关临床资料及CT特异征象进行单因素及多因素Logistic回归分析,确定脑出血患者出现早期脑血肿扩大的独立预测因素。结果两组患者发病至首诊CT检查的时间、脑实质血肿体积(ml),首诊CT血肿破入脑室的例数,脑室内血肿体积(ml),差异均有统计学意义(P<0.05)。同时两组患者的头颅CT平扫显示血肿内部征象、边缘征象、周围征象及联合征象比较,差异均有统计学意义(P<0.05),经多变量logistic回归分析,确定从发病到首诊CT检查时间、血肿的内部征象、边缘征象和联合征象可以独立预测早期脑血肿的扩大。结论首诊CT检查时间是早期血肿扩大的保护因素,颅脑CT平扫血肿的内部征象,边缘征象及联合征象为早期血肿扩大独立危险因素。

Objective To investigate the specific signs of hematoma on non-contrast CT scan,and to predict the risk factors of hematoma expansion in the early stage of intracerebral hemorrhage.Methods We retrospectively analyzed the patients diagnosed with cerebral hemorrhage in Qilu Hospital of Shandong University Dezhou Hospital from January 2019 to October 2022,the hematoma volume was measured by computer-aided measurement software,and the patients with intracerebral hemorrhage were divided into hematoma enlargement group and hematoma non-enlargement group.Univariate and multivariate Logistic regression analysis were performed on the relevant clinical data and CT specific signs of patients with cerebral hemorrhage to determine the independent predictors of early cerebral hematoma enlargement in patients with cerebral hemorrhage.Results Among the 172 patients with intracerebral hemorrhage,62 cases(36.05%)were in the enlarged hematoma group,and 110 cases(63.95%)were in the non-enlarged hematoma group.The time from onset to first CT examination,the volume of parenchymal hematoma(ml),the number of cases of first CT hematoma that broke into the ventricle,and the volume of intraventricular hematoma(ml)of the two groups were analyzed.The difference was statistically significant(all P<0.05).At same time,there were significant differences in the internal signs,edge signs,peripheral signs and combined signs of the hematoma on CT plain scan between the two groups(all P<0.05).Multivariate logistic regression analysis confirmed that the time from onset to the first CT examination,the internal signs,marginal signs and combined signs of hematoma can predict the expansion of early cerebral hematoma independently.Conclusion The time of first CT examination is a protective factor for early hematoma expansion,and the internal signs,edge signs and combined signs of hematoma on brain CT plain scan are independent risk factors for early hematoma expansion.