摘要
目的研究发病24h内的急性高血压性脑出血（AHCH）患者发生血肿扩大的危险因素。方法回顾性分析2008年3月-2013年3月广东省中医院符合纳入排除标准的AHCH患者256例的病例资料。收集患者的一般情况、既往病史、个人史、临床特点、CT检查结果、实验室检查指标、活血化瘀类中药使用情况。根据血肿扩大与否分为血肿扩大组与非血肿扩大组。首先对各项指标进行单因素分析,然后将经过单因素分析有统计学意义的因素作为自变量,血肿扩大结果作为因变量,采用多因素logistic回归分析法分析脑出血患者早期血肿扩大的独立相关因素。将各危险因素和血肿扩大作为自变量,3个月随访时以m RS（modified Rankin Scale）量表作为因变量,采用logistic回归分析急性期血肿扩大是否影响患者3个月的预后。m RS 0~2级为恢复良好,3~6级为严重致残或死亡。检验水准取α=0.05。结果 256例患者中,有43例发生了血肿扩大,血肿扩大发生率为16.80%。单因素分析结果显示,男性、入院GCS评分、入院NIHSS评分、病程、天冬氨酸转氨酶（AST）是导致血肿扩大的危险因素,而多因素分析则显示,仅男性、病程是导致血肿扩大的独立危险因素。此外,logistic回归分析结果显示血肿扩大是影响患者结局的独立危险因素,入院时血肿体积、病程、NIHSS评分也是影响患者3个月随访结局的独立危险因素。结论男性、发病到入院时间较短（2h内）的患者应警惕血肿扩大的风险,而出血量大、血肿再次扩大、高NIHSS评分、发病时间短则提示患者预后不良。
Objective To study the risk factors of hematoma enlargement in acute hypertensive cerebral hemorrhage （AHCH） patients within 24 hours after onset. Methods A retrospective review of clinical data of consecutive patients with AHCH who met the inclusion and exclusion criteria and admitted from Mar. 2008 to Mar. 2013 was performed. The patients＇ data included patients＇ demography, previous medical history, clinical features, findings of CT, results of laboratory examinations, and the use of traditional medicines for promoting blood circulation. Patients were divided into hematoma enlargement group and non-hematoma- enlargement group. Univariate analysis was performed on the above factors first, and then with the statistically significant factors used as independent variables, hematoma growth as dependent variables, logistic regression analysis was performed to investigate the possible independent relevant factors for the early enlargement of hematoma in AHCH patients. The risk factors and enlargement of hematoma served as independent variables, the data of mRS scale obtained from 3-month follow up as dependent variables, logistic regression was then performed to investigate the influence of acute hematoma enlargement during 3-month follow up in AHCH patients, mRS 0-2 was assigned as good recovery, and mRS 3-6 as serious disability or death. The inspection level was a=0.05. Results Among 256 patients, 43 （16.8%） were found to have hematoma enlargement. Univariate analysis showed the risk factors led to hematoma enlargement in AHCH patients were gender （male）, Glasgow coma scale at admission, NIHSS （National Institute of Health Stroke Scale） at admission, course of disease, and liver function （AST）. However, only two factors, namely gender （male） and course of disease, were the independent risk factors of the hematoma enlargement in AHCH patients according to the multivariate regression analysis. In addition, logistic regression revealed that the hematoma enlargement was the independent risk factor influencing the final outcome of AHCH patients, and the hematoma volume, NIHSS, and course of disease were the indepe.ndent risk factors influencing the outcome of 3 month follow up. Conclusions A male AHCH patient with shorter duration from onset to admission （within 2 hours） should alert attending physician there would be a risk of hematoma expansion. Larger amount of bleeding, enlarged hematoma, higher NIHSS and shorter duration from onset to admission herald a poor prognosis.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2015年第2期151-155,共5页
Medical Journal of Chinese People's Liberation Army
关键词
脑出血
血肿扩大
相关因素
hypertensive intracerebral hemorrhage, hematoma enlargement, Logistic regression analysis
