自发性脑出血血肿周围水肿扩大的危险因素分析

Risk factors analysis of perihematomal edema expansion in spontaneous cerebral hemorrhage

目的探讨引起自发性脑出血血肿周围水肿(perihematomal edema,PHE)扩大的危险因素。方法回顾性收集2018年1月至2020年12月在兰溪市人民医院收治的自发性脑出血患者临床资料,并对所有患者入院后当天、1~5 d、6~10 d、11~15 d内的头颅CT平扫进行脑血肿和PHE相关指标的评估。脑血肿CT值选择范围为37~100亨氏单位,PHE区域选择血肿周围密度骤减的5~23亨氏单位区域。出院时改良Rankin评分(m RS)0~2分定义为预后好,3~6分定义为预后差。结果共104例患者纳入最终研究。与预后好组(n=33)相比,预后差组(n=71)患者年龄更高,基线活化部分凝血活酶时间(APTT)更低,浅表血肿占比更低,PHE最大体积(the maximum PHE absolute volume,PHEAVmax)更大(皆P<0.05)。二元Logistic回归结果显示,PHEAVmax是出院时预后差的独立影响因素(OR=1.038,P=0.019)。线性回归分析结果显示,基线白蛋白水平(B=-1.501,P=0.025)、GCS评分(B=-3.440,P=0.015)与血肿扩张率(B=14.007,P=0.004)皆是影响PHEAVmax的独立危险因素。结论PHEAVmax是脑出血患者出院时预后差的独立危险因素,且患者的基线白蛋白水平、基线GCS评分和血肿扩张率与PHEAVmax独立相关。

Objective To investigate the risk factors of perihematomal edema(PHE)expansion in spontaneous intracerebral hemorrhage.Methods 104 patients with spontaneous intracerebral hemorrhage admitted to our hospital from January 2018 to December 2020 were retrospectively analyzed.The head CT scan of all patients within baseline,1-5 days,6-10 days and 11-15 days after admission were evaluated for hematoma and PHE related parameters.The area of hematoma on CT was selected with a threshold of 37 to 100 Hounsfield units,and the area of PHE with a threshold of 5 to 23 Hounsfield units.Good outcome at discharge was defined as Modified Rankin Scale(mRS)score 0-2,and poor outcome defined as mRS score 3-6.Results A total of 104 patients were included.Compared with the good outcome group(n=33),the patients in the poor outcome group(n=71)were with older age,lower baseline APTT,lower proportion of superficial hematoma,and larger maximum PHE absolute volume(PHEAVmax)(P<0.05).The results of binary logistic regression showed that PHEAVmax was an independent factor of poor prognosis(OR=1.038,P=0.019).The results of linear regression analysis showed that baseline albumin level(B=-1.501,P=0.025),GCS score(B=-3.440,P=0.015)and hematoma expansion rate(B=14.007,P=0.004)were independent risk factors affecting PHEAVmax.Conclusion Baseline plasma albumin level,hematoma expansion rate,and baseline GCS score were correlated with PHEAVmax in patients with spontaneous intracerebral hemorrhage,and PHEAVmax was associated with poor outcome at discharge.