血液病凝血功能障碍脑出血患者预后影响因素分析

目的 分析血液病凝血功能障碍脑出血患者预后的影响因素。方法 回顾性分析39例血液病凝血功能障碍脑出血患者的临床资料,根据血液病病种分组,收集患者发病年龄、性别、入院时临床症状、血压、意识、出血部位、凝血指标等,分析脑出血不良预后的危险因素。结果 Logistic回归分析入院时NIHSS评分(95%CI:1.24~3.18,P<0.05)、意识障碍程度(95%CI:5.47~217.19,P<0.001)、头晕乏力症状(95%CI:0.03~0.67,P<0.05)、头痛、恶心症状(95%CI:0.06~1.00,P<0.05)是血液病凝血功能障碍脑出血患者不良预后的危险因素。白血病组患者凝血酶原时间(PT)、国际标准化比值(INR)增高(P<0.05)。不同出血部位与PT延长、白细胞总数、INR和D-二聚体存在相关性(P<0.05)。结论 发病时NIHSS评分高、出现意识障碍、头晕、乏力、头痛、恶心症状可以较大程度预测血液病凝血功能障碍脑出血患者的不良预后。不同血液病病种中,白血病组预后最差。

Objective To explore the risk factors that may lead to poor prognosis of cerebral hemorrhage with hematologic coagulopathy cerebral hemorrhage.Methods The clinical data of 39 patients with cerebral hemorrhage of coagulation dysfunction in hematological diseases were retrospectively analyzed,grouped according to hematological diseases,and age of onset,gender,clinical symptoms at admission,blood pressure,consciousness,bleeding site,and coagulation indexes of the patients were collected to analyze the risk factors of poor prognosis of cerebral hemorrhage.Results Logistic regression analysis of NIHSS score(95%CI:1.24~3.18,P<0.05),degree of disturbance of consciousness(95%CI:5.47~217.19,P<0.001),dizziness and fatigue symptoms(95%CI:0.03~0.67,P<0.05),headache and nausea(95%CI:0.06~1.00,P<0.05)were risk factors for poor prognosis in patients with cerebral hemorrhage with blood disease coagulation disorder.The prothrombin time(PT)was significantly longer and the international normalized ratio(INR)was significantly higher in leukemia group(P<0.05).There was a correlation between different bleeding sites and prolonged PT,elevated total leukocyte count,PT INR and D-dimer(P<0.05).Conclusion The NIHSS score,the degree of consciousness disturbance,dizziness,fatigue,headache and nausea at onset can predict the poor prognosis of the patients.Among the different hematological conditions,the leukemia group had the worst prognosis.