脑室内出血后早期神经功能恶化的预测因素及远期预后分析

Risk factors associated with outcome of early neurological deterioration in intraventricular hemorrhage

目的 研究脑室内出血后早期神经功能恶化(early neurological deterioration,END)的危险因素及其与远期预后的关系。方法分析2020年1月至2022年1月绍兴市人民医院和绍兴市中心医院收治的出现早期神经功能恶化的脑室内出血患者的病例资料。依据是否出现END,分为END组、非END组;脑出血90 d后预后依MRS评分分为:预后良好组(0~3分)和预后不良组(4~5分);采用Logistic回归分析研究患者出现END的危险因素及其与90 d预后的关系。结果 在121例脑室内出血患者中,37例患者(30.6%)出现END,END组中神经功能恶化的危险因素包括较高的入院SBP,较大的基线血肿体积、血肿增大、脑室扩大以及WBC升高。END组死亡率及90天随访预后不良率均显著高于非END组(40.5%∶7.1%;45.9%∶34.5%),差异有统计学意义(P<0.05)。结论 较高的入院SBP、较大的基线血肿体积、血肿增大、脑室扩大以及WBC升高是脑室内出血后早期神经功能恶化的独立危险因素,早期神经功能恶化患者有较高的死亡率及远期预后不良率,需要尽早识别早期神经功能恶化的相关危险因素并采取相应措施以便提高生存率及改善患者预后。

Objective To study the risk factors associated with outcome of early neurological deterioration(END)in intraventricular hemorrhage.Methods A Multi-center prospective cohort study was performed between 1 January 2020 and 1 January 2022 for patients with early neurological deterioration after intraventricular hemorrhage in Shaoxing People's Hospital and Shaoxing Central Hospital.Logistic regression was used to identify predictors and effects of neurological deterioration.Results In 121 patients,37(30.6%)patients had END.The predictors of END included higher systolic blood pressure,larger baseline hematoma,progressive hematoma enlargement,ventricular enlargement,higher index of WBC.END was independently associated with higher mortality rate and Modified Rankin Scale(MRS)of 90 days of follow-up.The mortality rate and the poor prognosis rate in END group were significantly higher than those in the non-END group(P<0.05).Conclusion Higher systolic blood pressure,larger baseline hematoma,progressive hematoma enlargement,ventricular enlargement and higher index of WBC increased the risk of END.END increased the risk of death and dependency at day 90.It was necessary to early identify the relevant risk factors of END and took corresponding measures to improve the survival rate and prognosis of patients。