院前急救对高血压脑出血血肿扩大的影响

Effect of pre-hospital care on hematoma expansion in patients with hypertensive cerebral hemorrhage

目的探究高血压脑出血(hypertensive cerebral hemorrhage,HICH)患者院前救治过程血肿扩大的危险因素。方法回顾性分析2019年1月至2021年6月经连云港市急救中心转运救治的169例HICH患者的临床资料,根据院前救治期间患者前后两次CT出血量的比较分为血肿扩大组(42例)和血肿未扩大组(127例)。采用多因素Logistic回归分析患者血肿扩大的危险因素。结果血肿扩大组患者入院时的收缩压、血肿体积差均高于血肿未扩大组,降压药、脱水药的使用比例低于血肿未扩大组,转运时间长于未扩大组,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示未使用降压药(OR=48.526,95%CI:7.778~302.737,P=0.001)、未使用脱水药(OR=12.330,95%CI:3.084~49.2%,P=0.001)、入院时收缩压(OR=1.157,95%CI:1.082~1.238,P=0.001)是HICH患者急救转运途中血肿扩大的危险因素;首次出血量(OR=0.893,95%CI:0.849~0.938,P=0.001)可能是血肿扩大的保护因素。结论HICH患者在院前急救过程中,未控制的高血压及较长的转运时间是血肿扩大的危险因素。

Objective To analyze the possible influencing factors of hematoma expansion in patients with hypertensive cerebral hemorrhage(HICH)during pre-hospital treatment.Methods The emergency clinical data of 169 cases patients with HICH treated in Lianyungang Emergency Center from January 2019 to June 2021 were collected retrospectively.According to the comparison of the two cranial CT bleeding volumes,they were divided into hematoma expansion group(42 cases)and hematoma non expansion group(127 cases).Multivariate Logistic regression were used to analyze the possible influencing factors of hematoma expansion.Results The change of systolic blood pressure,hematoma volume difference in the hematoma expansion group were higher than those in the non expansion group.The proportion of antihypertensive drugs,dehydrating drugs during transmission were lower than those in non expansion group.The transit time was higher than that in the non expansion group(P<0.05).Multivariate Logistic regression analysis showed that non antihypertensive drugs(OR=48.526,95%CI:7.778-302.737,P=0.001),non dehydrating drugs(OR=12.330,95%CI:3.084-49.296,P=0.001),systolic blood pressure at admission(OR=1.157,95%CI:1.082-1.238,P=0.001)were the risk factors of hematoma expansion in patients with HICH during pre-hospital care.Initial hematoma volume may be a protective factor(OR=0.893,95%CI:0.849-0.938,P=0.001).Conclusion Uncontrolled hypertension and longer transit time are related risk factors for hematoma enlargement in patients with HICH during pre-hospital care.