影响ICH患者血肿扩大的因素及预后观察

摘要

目的：研究影响脑出血（ICH）患者血肿扩大的因素和影响ICH患者预后的因素。方法回顾性分析200例脑出血患者的临床资料，根据头颅CT复查结果分为血肿扩大组（Ⅰ组）和非血肿扩大组（Ⅱ组），记录两组患者的一般临床特征、实验室指标等，分析影响血肿扩大的因素；同时将入组患者按照mRS评分分为预后不良组（A组）和预后良好组（B组），研究影响预后的因素。结果Ⅰ组患者相比Ⅱ组患者，首次CT检查距发病时间＞4 h人数（15 VS 71）、入院时收缩压[（106.32±17.42） VS（98.76±15.67）]、入院时舒张压[（180.21±23.08）VS（170.21±20.10）]、意识障碍发生率（66.7% VS 32.1%）均显著增加，差异具有统计学意义（P＜0.05）；A组患者血肿扩大发生率（58.06% VS 30.26%）、意识障碍发生率（32.3% VS 13.2%）和入院时NIHSS评分[（17.27±2.23）VS（11.71±1.43）]与B组相比显著增加，均具有统计学意义（P＜0.05）。结论首次CT检查距发病时间、入院时收缩压、血肿形态、意识障碍为血肿扩大的影响因素；血肿扩大、意识障碍率和入院时NIHSS评分为影响预后的相关因素，有效控制血肿扩大能显著改善ICH患者病情，值得临床医师重视。%Objective To explore the impact factors of enlargement of hematoma and prognosis of intracerebral hemorrhage. Methods A total of 200 patients confirmed with ICH from January 2010 to December 2014 were analyzed retrospectively. Accord-ing to CT changes, patients were divided into hematoma expansion group(group Ⅰ) and non-expansion group(group Ⅱ), clinical characteristics and laboratory paremeters of both groups were recorded, in order to explore the impact factors of enlargement of he-matoma. At the same time, patients were divided into poor-prognosis group(group A) and good-prognosis group(group B) in order to explore the prognosis in Intracerebral Hemorrhage. Results Group I patients compared with group II patients, the number of pa-tients with the first CT examination from the time of onset was greater than 4 h(15 VS 71), systolic blood pressure at admission [(106.32 ± 17.42) VS (15.67 ± 98.76)], diastolic blood pressure at admission[(180.21 ± 23.08) VS (20.10 ± 170.21)], awareness rate (66.7%VS 32.1%) were significantly increased, the difference was statistically significant(P<0.05);Compared with the B group, the incidence of hematoma enlargement(58.06%VS 30.26%), incidence of disturbance of consciousness(32.3%VS 13.2%) and NIHSS score at admission[(17.27±2.23) VS (1.43±11.71) ]in group A was significantly increased, the difference was statistically significant (P<0.05). Conclusion Time from onset to first CT, the shape of hematoma, systolic blood, diastolic blood pressure and disturbance of consciousness are impact factors of enlargement of hematoma in intracerebral hemorrhage, while incidence of hematoma enlarge-ment, disturbance of consciousness and the shape of hematoma are impact factors of prognosis of patients with ICH.