脑出血早期血肿扩大的危险因素及预后的相关性研究

发布时间：2018-02-03 20:29

  本文关键词： 脑出血 早期血肿扩大 危险因素 预测 预后　出处：《泸州医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨脑出血后早期血肿扩大的各种危险因素及与预后的相关性。资料与方法：1、前瞻性登记2012年6月1日-2013年11月1日前往四川省人民医院就诊的所有神经内科、神经外科的脑出血患者。纳入发病24h以内入院接受治疗的自发性脑出血患者，详细收集所有与早期血肿扩大相关的指标，包括CT影像学特征、临床数据及实验室检查结果等。所有患者如病情加重立即复查头颅CT，病情平稳则在发病72h内复查头颅CT。复查头颅CT结果与初始CT对比判断是否出现早期血肿扩大（Hematoma Enlargement，HE），如果血肿体积增大33%或血肿直径增加10%则视为血肿扩大。根据血肿是否扩大，将患者分为血肿扩大组（HE）及非血肿扩大组（non-HE，NHE）。2、随访时间点为发病后的3个月和6个月，，通过电话或门诊进行随访，主要包括：1）生存状态2)有无残疾。残疾判定采用改良Rankin评分量表(Modified Rankin Scale，MRS)。MRS分值3到5分为残疾，MRS分值0到2分为生活自理。3、计量资料采用均数±标准差（x±s）或中位数描述。两组计量资料比较，若数据服从正态分布，采用t检验；若非正态分布，采用秩和检验。计数资料采用百分比描述。两组计数资料比较，采用卡方检验。对各种危险因素进行单因素分析，确定脑出血后早期血肿扩大的危险因素。单因素分析中P≤0.10者进一步多因素分析，排除校正混杂因素，确定血肿扩大的独立危险因素。同时观察血肿扩大对脑出血患者3月和6月死亡/残疾的影响。结果：1、本研究共纳入符合标准的病例233例，男性157（67.4%）例，女性76（32.6%）例；年龄范围为21-92岁；平均年龄61.5±14.3岁；233例患者中，发生血肿扩大者46例（19.7%）；未发生血肿扩大者187例(80.3%)。2、血肿扩大多发生在6h以内，血肿扩大部位多位于基底节区。3、血肿形态、发病6h内CT检查两组间差异有统计学意义。多因素回归分析结果显示包括血肿形态（OR3.125,95%CI1.188～8.215）、发病6h内CT检查（OR4.862,95%CI1.705～13.862）是自发性脑出血患者血肿扩大的独立危险因素。4、自发性脑出血后血肿扩大加重神经功能缺损，是自发性脑出血预后不良的独立危险因素。血肿扩大（OR9.098,95%CI3.991～20.741）是影响脑出血患者发病后3月末死亡/残疾的危险因素。血肿扩大（OR6.844,95%CI2.818～16.626）是影响脑出血患者发病后6月末死亡/残疾的危险因素。结论：1、自发性脑出血早期血肿扩大的发生率较高，本研究为19.7%；2、血肿扩大的独立预测因素是血肿形态和发病6h内CT检查。血肿形态越不规则、发病至首次CT检查时间越短发生血肿扩大的几率越高；3、血肿扩大是脑出血患者3月及6月死亡/残疾的危险因素。血肿扩大的高危患者，应积极安排影像学检查，及早发现血肿扩大，尽早调整治疗方案。
[Abstract]:Objective: to investigate the risk factors of early hematoma enlargement after intracerebral hemorrhage and its correlation with prognosis. Prospective registration of all neurology departments visiting Sichuan Provincial people's Hospital from June 1st 2012 to November 1st 2013. Patients with intracerebral hemorrhage in neurosurgery. Included in patients with spontaneous intracerebral hemorrhage who were admitted to hospital within 24 hours after the onset of the disease, and collected all the indicators related to the enlargement of early hematoma, including CT imaging features. Clinical data and laboratory results. All patients with exacerbation of the disease immediately review the skull CT. The stable state of the disease was followed up within 72 hours after the onset of the disease. The results of CT were compared with those of the initial CT to determine whether there was early hematoma enlargement and hematoma Enlargement. If the hematoma volume increases by 33% or the hematoma diameter increases by 10%, the hematoma is deemed to be enlarged, depending on whether the hematoma is enlarged or not. The patients were divided into hematoma enlargement group and non-hematoma enlargement group. The follow-up time was 3 months and 6 months after onset, and followed up by telephone or outpatient. The main results were as follows: 1) living state 2) disability. The modified Rankin score scale was used to determine disability with modified Rankin Scale. MRS).MRS scores of 3 to 5 were divided into disability Mrs score 0 to 2 as self-care of living. The metrological data were described by mean 卤standard deviation (x 卤s) or median. The two groups were compared with each other. If the data is from normal distribution, t test is used. If it is not normal distribution, rank sum test is used. The counting data is described by percentage. Two groups of counting data are compared and chi-square test is used to analyze all kinds of risk factors. To determine the risk factors of early hematoma enlargement after intracerebral hemorrhage. In univariate analysis, P 鈮

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