重症脑出血伴颅内压升高患者的临床特征及预后的前瞻性研究

摘要

目的 探讨重症脑出血(ICP)合并颅内压升高的病例特点及其与脑出血结果的相关性.方法 回顾性持续纳入自发性脑出血行ICP监护的患者,自护理记录收集每小时的ICP值.多元回归分析检测与颅内压升高有关的危险因素.有序多分类Logistic回归模型检测颅内高压与发病12个月后的mRS相关性.结果 纳入186例患者,47例(25％)进行了ICP监护,其中30例(70％;95％ CI 47％～80％)合并ICP＞ 20 mmHg.年纪更大(OR每10 a0.6,95％ CI 0.25～0.85)、幕下出血(OR0.1,95％ CI 0～0.7)的患者往往更少出现颅内压升高.颅内高压定义为ICP＞25 mmHg时,高龄(OR每10 a0.6,95％ CI0.25～0.85)及幕下出血(OR 0.1,95％ CI 0～0.75)均显示预测颅内高压差异有统计意义.颅内高压与随访12个月mRS评分无显著相关(OR 0.8,95％ CI 0.3～2.5).把颅内高压定义为ICP＞25 mmHg、ICP升高数或ICP升高曲线下面积进行敏感性分析时,结果仍旧同上.3例颅内高压患者(16 ％)ICH 12个月后显示可恢复至功能独立(mRS 0～2).结论 ICH颅内高压较常见,特别是年纪较轻及幕上出血患者.在对合并高颅内压的患者给予积极治疗后,显示高颅内压不一定与长期预后相关,提示高颅内压并非一定是预后差的危险因素.%Objective Background To investigate the clinical spectrum and prognosis of intracranial hypertension after ICH.Methods Spontaneous ICH patients underwent ICP monitoring were included in this study.We obtained the patients'hourly ICP values from nursing documentation.Multiple Logistic regression was used to explore factors associated with intraeranial hypertension,and ordinal logistic regression controlling for the ICH score to examine the relationship between intracranial hypertension and the mRS score at 12 months.Results Among 186 patients,47 (25％) underwent ICP monitoring,of whom 30 (64％,95％ CI 47 ％～80％) had an episode of ICP＞20 mmHg.Intracranial hypertension was less likely in older patients (OR per decade 0.6,95 ％ CI 0.25～0.85) and after infratentorial hemorrhage (OR 0.1,95 ％ CI 0 ～0.75).Intracranial hypertension was not independently associated with mRS scores (OR 0.8,95％ CI 0.3～2.5);this remained true for a threshold of ＞25 mmHg (OR 0.5,95％ CI 0.25～1.5),number of elevations (OR 0.98 per elevation,95 ％ CI 0.96～1.00),or area under the curve (OR 1.00 per mmHg 9 h,95 ％ CI 0.99 ～ 1.01).Among patients with intracranial hypertension,three (16％) were functionally independent (mRS 0～2) at 12 months.Our results were not significantly changed after excluding patients with early DNR orders.Conclusion Intracranial hypertension is common after ICH,especially in younger patients with supratentorial hemorrhage.Given active treatment of elevated ICP,intracranial hypertension does not appear associated with long-term outcomes,suggesting that ICP elevations should not necessarily be taken to signify a poor prognosis.