高血压脑出血患者预后相关因素分析

目的 研究急性高血压脑出血患者90d预后的相关因素，为临床治疗提供指导。方法 本研究是一项前瞻性队列研究，在2006年1月至2007年10月，共连续入选发病3h之内的自发性高血压脑出血患者73例。患者入院时收集人口学资料、既往病史、实验室检查，在基线（发病3h之内），24±3h，72±3h进行颅脑计算机断层扫描（computed tomography，CT），获取影像学资料，并在上述时间点及发病90d进行神经功能评分：美国国立卫生院卒中评分（National Institutes of Health Stroke Scale，NIHSS），格拉斯哥昏迷评分（Glasgow Coma Scale，GCS），改良的Rankin评分（modified Rankin Scale，mRS）。结果 对73例发病3h之内的高血压脑出血患者研究发现：发病3h之内乳酸脱氢酶（P＝0.026）、纤维蛋白原（P=0.012）、血沉（P=0.001）、肌酐（P=0.036）、基线水平GCS（P=0.001）和NIHSS评分（P=0.002）、住院期间发生感染（P=0.001）、手术（P=0.014）、血肿大小（P<0.01）、绝对水肿大小（P<0.01）、发病24h血肿扩大（P＝0.002）、出血破入脑室系统（P＝0.001）、影像学具有占位效应（P＝0.003）与患者90d mRS临床结局具有相关性。结论 高血压脑出血患者感染、手术、所观测时间点血肿体积、绝对水肿体积、发病24h血肿扩大、出血破入脑室系统、影像学具有占位效应、基线的乳酸脱氢酶、纤维蛋白原、血沉、肌酐、基线水平GCS和NIHSS评分与患者90d临床结局具有相关性，控制这些因素有可能改善预后。

Analysis of Predictors Correlated with the Prognosis 90 Days After Hypertensive Cerebral Hemorrhage

Objective To identify the predictors correlated with the prognosis 90 days after hypertensive cerebral hemorrhage.
Methods 73 spontaneous hypertensive cerebral hemorrhage patients within 3 hours after onset were enrolled into our study during January 2006 to October 2007. The demographic data, past history and laboratory examination were recorded. We assessed the neurologic deficit at several time spot using the U.S National Institutes of Health Stroke Scale（NIHSS）, Glasgow Coma Scale（GCSe and modified Rankin Scale（mRS）. Computed tomography scans at baseline, 24±3hours, and 72±3hours were performed separately. All factors correlated with 90 days’ prognosis and hematoma volume in baseline were analyzed.
Results Among all recruit patients, Independent-Samples T Test revealed those factors including lactate dehydrogenase（P=0.026）, erythrosedimentation（P=0.001）, blood sedimentation（P=0.001）, creatinine（P=0.036）, glasgow coma scale（GCS） at baseline（P=0.001）, fibrinogen（P=0.012）, medlineshift, infection, NIHSS（P=0.002）, GCS（P=0.001）, infection while hospitalization （P=0.001）, operation（P=0.014）, hematoma size（P〈0.01）, absolute edema size（P〈0.01）, hematoma enlargement in 24 hours（P=0.002）, bleeding ruptured into ventricular system（P=0.001）, medline shift（P=0.003） were correlated with 90 days outcome.
Conclusion In this study, we found factors including hematoma volume, absolute perihemotoma edema, blood ruptured into ventricular system, hyperfibrinogenemia, creatinine, lactate dehydrogenase, erythrosedimentation medlineshift, infection, NIHSS, GCS correlated to the poor outcome. In clinical treatment, we should focus on the primary lesions so to improving the outcome.