脑出血再发危险因素的分析

目的研究脑出血患者再发脑出血的相关因素，为临床预防和治疗再出血提供参考。方法回顾性分析3672例脑mm上患者中再发脑出血的临床资料，分为再次出血组239例，初次出血组3433例。先经单因素分析，筛选出差异有统计学意义的危险因素，再经多元Logistic回归分析，确定再发脑出血的独立危险因素。结果①3672例患者再发脑出血的发生率为6．5％（239／3672），脑出血再发的病死率为19．2％（46／239）。②单因素分析显示，脑出血再发与高血压、服用抗血小板聚集药物、糖尿病、长期吸烟及酗酒等相关；两组比较，再出血组患者糖尿病史、长期吸烟、口服抗凝药、平均收缩脉升高、平均舒张压升高的比例均高于初次出血组；出血部位中，基底核区比例亦较高，年龄较大，两组比较均P〈0．01。③Logistic多元回归分析筛选出平均舒张压（OR=8．7893，95％CI：5．0162～18．9358）、抗凝药的应用（OR=3．7273，95％CI：1．8245～5．7806）、长期吸炯（OR=3．1654，95％CI：1．6124～5．4528）、平均收缩压（OR=2．9463，95％CI：1．4596～4．9753）及糖尿病（OR=2．4689，95％CI：1．1807～4．7650）是脑出血再发的独立危险因素，均P〈0．05。结论脑出血患者的再发出血与平均舒张压升高、抗凝药的应用、长期吸烟、平均收缩压升高及糖尿病具有相关性。

Analysis of risk factors for recurrent intracerebral hemorrhage

Objective To investigate the related factors of recurrent intracerebral hemon-hage in patients with intracerebral hemorrhage in order to provide references for prevention and treatment. Methods The clinical data of recurrent intraeerebral hemorrhage in 3672 patients with intracerebral hemorrhage were analyzed retrospectively. They were divided into recurrent intraeerebral hemorrhage group （ n = 239） and first attack of intracerebral hemorrhage group （ n = 3433 ）. The univariate analysis was performed first, and the risk factors with significant statistical difference were screened, and then a multivariate logistic regression analysis was used to determine the independent risk factors for recurrent intracerebral hemorrhage. Results ① The incidence of recurrent intraeerebral hemorrhage in 3672 patients was 6. 51% （239/3672） and the mortality of recurrent intracerebral hemorrhage was 19.25% （46/239）. ②The univariate analysis showed that recurrent intraeerebral hemorrhage was associated with hypertension, taking anti-platelet aggregation agents, diabetes mellitus, long history of smoking, and alcoholism. The proportions of patients with history of diabetes mellitus, long history of smoking, oral take of anticoagulants, systolic blood pressure and diastolic blood pressure in the recurrent intracerebral hemorrhage group were significantly higher than those in the first attack of intracerebral hemorrhage group. Among the sites of bleeding, the basal ganglia region was higher, and the age of patients were older （ all P 〈 0.01 ）. ③Amul- tivariate stepwise logistic regression analysis revealed that the mean diastolic blood pressure （ OR = 8. 7893, 95% CI：5. 0162 - 18. 9358 ）, use of anticoagulants （OR =3. 7273,95% CI：I. 8245 -5. 7806）, long history of smoking （ OR = 3. 1654,95% CI： 1. 6124 - 5.4528）, high systolic blood pressure （ OR = 2. 9463,95% CI： 1. 4596 -4. 9753）, and diabetes mellitus （OR = 2.4689,95% CI： 1. 1807 -4.7650） were the independent risk factors for patients with recurrent intraeerebral hemorrhage. Conclusion Recurrent cerebral hemorrhage in patients with cerebral hemorrhage is correlated with the higher diastolic blood pressure, use of anticoagulants, long history of smoking, higher systolic blood pressure, and diabetes mellitus.