高血压所致小量幕上脑出血患者早期血肿扩大的危险因素分析

目的高血压脑出血为神经科一种常见病,死残率高,临床个体情况差异较大,治疗上存在较大争议。文中分析高血压所致小量幕上脑出血(supratentorial hypertensive intracerebral hemorrhage,STHH)早期影响血肿扩大的危险因素,为临床治疗提供参考。方法回顾性分析自2007年6月至2011年6月急诊发病6 h内住院并确诊为STHH患者106例的临床资料,根据其24 h内复查CT分为血肿扩大组及未扩大组,通过单因素和Logistic多因素回归分析,确定发病早期影响血肿扩大的相关因素。结果本组106例中24h内血肿明显扩大38例(35.85%),其中22例采取急诊手术,无死亡病例。单因素统计结果表明,凝血功能异常、未应用止血剂、应用脱水剂、躁动、血压控制不稳定等因素,与发病早期血肿扩大有关(P<0.05)。进一步多因素回归分析显示血压控制不稳定、应用脱水剂为血肿扩大的危险因素(P<0.05)。结论治疗措施是否规范对STHH发病早期血肿扩大有重要影响,血压控制达标、及时应用止血剂、保持安静、慎用脱水剂等将有助于稳定病情。

Risk factors of early hematoma enlargement in small-volume supratentorial hypertensive intracerebral hemorrhage

Objective Hypertensive intracerebral hemorrhage is one of the most common diseases in neurology,with high rates of mortality and disability.There is much controversy about its treatment because of varied clinical conditions of individual patients.This article was to investigate the risk factors of hematoma enlargement(HE) in the early stage of small-volume supratentorial hypertensive intracerebral hemorrhage(STHH).Methods We retrospectively analyzed the clinical data of 106 small-volume STHH patients admitted within 6 h after onset.According to CT re-scan results within 24 h after admission,we divided the patients into HE and non-HE groups,and determined the risk factors of HE by univariate and multivariate analyses.Results Of the 106 patients,38(35.85%) developed HE within 24 h,22 received surgical intervention,and no death occurred.Univariate analysis showed that early occurrence of HE was significantly associated with failed haemostatic medication,use of dehydration drugs,unsatisfactory sedation,and bad blood pressure control(P<0.05).Multivariate logistic regression analysis showed the risk factors to be bad blood pressure control and use of dehydration drugs(P<0.05).Conclusion Therapeutic measures are closely associated with early hematoma enlargement in STHH.Effective blood pressure control and sedation,timely haemostatic medication,and appropriate use of dehydration drugs may contribute a lot to the prevention of hemotoma enlargement.