脑出血血肿增大预测因素的研究进展

正脑出血有较高的病死率及致残率,而血肿增大则严重影响病人预后。因此,早期评估血肿增大风险并予以针对性治疗有助于改善病人预后。近年来,血肿增大预测因素的研究很多。本文详细总结了血肿增大的相关预测因素,从病人性别、血压、实验室检查、影像学检查等方面作一综述,从而更具针对性的预测血肿增大风险。1性别有多变量分析认为男性脑出血病人的血肿增大风险及早晚期病死率高于女性脑出血病人,其机制有待进一步研究~([1])。其原因可能为:不同性别病人脑     

自发性脑出血患者早期血肿增大的危险因素分析

目的探讨自发性脑出血（SICH）患者早期血肿增大的危险因素。方法对105例SICH患者发病后48h进行动态CT检查,观察血肿的体积变化,血肿量平均增大33％或者6ml以上定为血肿增大。结果本组16例患者血肿增大,89例患者血肿未增大。单因素分析发现,患者年龄、入院时国际标准化比率较高、平均动脉压较高、既往有高血压病史、影像学检查示白质疏松及初始血肿体积较大的SICH患者易发生早期血肿增大。多因素Logistic回归分析发现,高血压病史（优势比为3．683,95％可信区间为1．057～12．837,P〈0．05）、头部CT示白质疏松（优势比为4．665,95％可信区间为1．437～15．129,P〈0．05）是SICH患早期血肿增大的独立危险因素。结论SICH患者早期血肿增大与诸多因素相关,人院后动态头部CT检查有助于早期发现。     

脑出血患者早期血肿扩大相关危险因素的临床分析

目的探讨脑出血后早期血肿增大的相关危险因素。方法299例脑出血患者,根据病情演变及脑CT变化,分为血肿增大组和血肿稳定组,对两组患者病史、临床特点、生化指标及头颅CT特征进行对比分析。结果299例患者中,69例出现血肿增大,发生率为23%,其中23例发生在24h内;基底节区不规则血肿、血压持续升高、肝功能受损、大量饮酒及长期口服抗血小板聚集药物的患者,易发生血肿扩大,两组比较有显著性差异(P(0.05)。结论脑出血后血肿增大多发生在24h内,长期口服抗血小板聚集药物、发病后血压持续增高、肝功能受损可能为血肿增大的主要危险因素。     

原发性脑出血患者血肿增大的影响因素及血栓弹力图参数的预测价值

目的 分析原发性脑出血患者血肿增大的影响因素及血栓弹力图(TEG)参数的预测价值.方法 选取葛洲坝中心医院2018-01—2019-10收治的85例原发性脑出血患者,回顾性分析原发性脑出血患者的相关资料(包括临床资料、CT检查资料),分析血肿增大(20例,定义为发病后48 h内复查CT检查血肿体积相比入院时增加>33％...     

淀粉样脑血管病相关性脑出血的病理研究

目的 研究新疆少数民族地区自发性脑出血患者中淀粉样脑血管病相关性脑出血(CAAH)的比例及其病理特点.方法 经头颅CT证实为自发性脑出血的124例患者来自于有代表性的南北疆6家三级甲等医院,入组患者接受开颅手术,标本取白血肿腔周围,通过HE染色、刚果红染色偏振光显微镜观察、β淀粉样蛋白(Aβ)免疫组化检测明确是否存在脑血管淀粉样变性.结果124例患者中11例为CAAH,占8.9％,其中4例为嗜刚果红血管病,1例表现为斑样血管病,6例为混合型.结论 新疆少数民族地区手术治疗的自发性脑出血患者中8.9％与淀粉样脑血管病(CAA)相关,其比例随年龄增加;CAA表现为受累的血管壁增厚,血管壁正常结构消失,淀粉样物质在血管被膜中层和外膜中沉积;部分患者脑实质内可见β淀粉样蛋白沉积.     

脑出血早期血肿扩大的相关因素研究新进展

<正>脑出血(intracerebral hemorrhage,ICH)指原发性非外伤性脑实质内出血,是目前全球主要的公共卫生负担之一^[1]。本文从ICH早期血肿扩大与预后的相关性、早期血肿扩大的影像学、实验室及临床的影响因素等阐述ICH早期血肿扩大相关因素的研究进展,为ICH诊治提供新思路。1早期血肿扩大和ICH预后的相关性ICH病人早期血肿扩大发生率在38%～73%。早期血肿扩大定义为从首次CT扫描开始计算,24 h内血肿体积量增大>33%或绝对增多>12.5 ml^[2,3]。     

淀粉样脑血管病的病理

26例淀粉样脑血管病(CAA)中,脑出血20例,蛛网膜下腔出血2例,脑梗塞3例,硬膜下血肿1例。CAA主要累及脑实质的小、中动脉的中膜及外膜以及毛细血管。本组50％病例有淀粉样脑血管病伴随血管病(CAA-AV),包括微小动脉瘤、“双桶”、葱皮样改变、类纤维素性坏死、微小动脉丛及血管周围淋巴细胞浸润。CAA往往同时伴有老年斑和神经原纤维缠结。     

高血压脑出血患者急性期血肿扩大的相关因素

目的 探讨高血压脑出血(CH)患者急性期血肿扩大的相关因素.方法 对208例CH患者(其中29例发生血肿扩大)的临床资料进行回顾性分析.结果 血肿扩大组在发病≤24 h发生血肿扩大者27例(93.1%).与无血肿扩大组比较,血肿扩大组的收缩压显著增高;并且血肿扩大组Glasgow昏迷量表(GCS)评分降低、基底节出血、肝功能异常、长期饮酒、服阿司匹林和糖尿病史的比率显著高于无血肿扩大组(P<0.05～0.005).结论 CH患者发病时收缩压高、病情重、基底节出血以及有肝功能异常、长期饮酒、服阿司匹林和糖尿病是血肿扩大的相关因素.对CH患者应重视或控制这些有关因素,以防治CH后继续出血、血肿扩大.     

高血压脑出血患者早期血肿扩大的相关因素分析

目的探讨高血压性脑出血早期血肿扩大的发生率以及相关影响因素。方法回顾分析217例高血压性脑出血患者的CT检查结果,分为血肿扩大组和对照组,对首次CT检查距发病时间、血肿部位及形态、出血量、入院时血压、是否长期服用阿司匹林、饮酒史等逐一对比研究。结果高血压性脑出血存在早期血肿扩大的现象,发生率为15.7%,病后血压水平、出血部位及血肿形态、是否长期服用阿司匹林、长期饮酒等因素与血肿扩大存在因果关系。结论脑出血后血肿扩大多发生在出血后24h内,高血压、出血部位靠近中线、血肿形态不规则、长期服用阿司匹林、长期饮酒等是血肿扩大的独立危险因素。     

高血压脑出血血肿扩大相关因素分析

目的通过对比分析明确幕上高血压脑出血血肿扩大的危险因素。方法将幕上高血压脑出血患者313例,根据是否存在血肿扩大,分为血肿扩大组和非血肿扩大组,明确血压、早期使用甘露醇、血肿特点、发病时搬动与血肿扩大的关系。结果 (1)血肿扩大组入院时收缩压200mmHg者占40.34%,非血肿扩大组占12.37%;血肿扩大组入院时舒张压110mmHg者占57.14%,非血肿扩大组占26.80%,两组比较,血肿扩大组血压明显高于非血肿扩大组,差异显著(P0.01)。(2)血肿扩大组早期(发病6h内)使用甘露醇者占85.71%,非血肿扩大组占54.12%,差异显著(P0.01)。(3)血肿扩大组丘脑出血占38.66%,显著多于非血肿扩大组的26.28%(P0.05);血肿扩大组出血量20ml者58.82%,显著高于非血肿扩大组的16.50%(P0.01);血肿扩大组血肿形态不规则者93.28%,显著高于非血肿扩大组的61.34%(P0.01)。(4)血肿扩大组存在搬动史者57.98%,非血肿扩大组41.75%,差异显著(P0.01)。结论血压升高(收缩压200mmHg和/或舒张压110mmHg)、发病早期(6h内)使用甘露醇、丘脑出血、出血量大于20ml、血肿形态不规则、发病早期存在搬动是脑出血血肿扩大的危险因素。     

Diagnostic utility of amyloid PET in cerebral amyloid angiopathy-related symptomatic intracerebral hemorrhage

By detecting β-amyloid (Aβ) in the wall of cortical arterioles, amyloid positron emission tomography (PET) imaging might help diagnose cerebral amyloid angiopathy (CAA) in patients with lobar intracerebral hemorrhage (l-ICH). No previous study has directly assessed the diagnostic value of ¹¹C-Pittsburgh compound B (PiB) PET in probable CAA-related l-ICH against healthy controls (HCs). ¹¹C-PiB-PET and magnetic resonance imaging (MRI) including T2* were obtained in 11 nondemented patients fulfilling the Boston criteria for probable CAA-related symptomatic l-ICH (sl-ICH) and 20 HCs without cognitive complaints or impairment. After optimal spatial normalization, cerebral spinal fluid (CSF)-corrected PiB distribution volume ratios (DVRs) were obtained. There was no significant difference in whole cortex or regional DVRs between CAA patients and age-matched HCs. The whole cortex DVR was above the 95% confidence limit in 4/9 HCs and 10/11 CAA patients (sensitivity=91%, specificity=55%). Region/frontal or occipital ratios did not have better discriminative value. Similar but less accurate results were found using visual analysis. In patients with sl-ICH, ¹¹C-PiB-PET has low specificity for CAA due to the frequent occurrence of high ¹¹C-PiB uptake in the healthy elderly reflecting incipient Alzheimer''s disease (AD), which might also be present in suspected CAA. However, a negative PiB scan rules out CAA with excellent sensitivity, which has clinical implications for prognostication and selection of candidates for drug trials.     

Neuroimaging biomarkers of small vessel disease in cerebral amyloid angiopathy-related intracerebral hemorrhage

Aims

The significance of the correlation of computed tomography (CT)–based cerebral small vessel disease (SVD) markers with the clinical outcomes in patients with cerebral amyloid angiopathy (CAA)-related intracerebral hemorrhage (ICH) remains uncertain. Thus, this study aimed to explore the relationship between SVD markers and short-term outcomes of CAA-ICH.

Methods

A total of 183 patients with CAA-ICH admitted to the Xuanwu Hospital, and Beijing Fengtai You'anmen Hospital, from 2014 to 2021 were included. The multivariate logistic regression analysis was performed to identify the correlation between SVD markers based on CT and clinical outcomes at 7-day and 90-day.

Results

Of the 183 included patients, 66 (36%) were identified with severe SVD burden. The multivariate analysis showed that the total SVD burden, white matter lesion (WML) grade, and brain atrophy indicator were independent risk factors for unfavorable outcomes at 90-day. The brain atrophy indicator was independently associated with mortality at 90-day. Severe cortical atrophy was significantly associated with early neurological deterioration.

Conclusions

The neuroimaging profiles of SVD based on CT in patients with CAA-ICH might predict the short-term outcome more effectively. Further studies are required to validate these findings and identify modifiable factors for preventing CAA-ICH development.     

控制血压防止高血压脑出血血肿扩大的研究

目的研究控制血压对防止高血压脑出血血肿扩大的效果。方法将96例病程<3h,平均动脉压(MAP)>130mmHg(1mmHg=0.133kPa)的高血压脑出血患者随机分为治疗组(48例)和对照组(48例);治疗组采用舌下含服卡托普利12.5～25mg,每3～4h1次,使MAP≤130mmHg并维持到病后24h,对照组不用任何降压药物,观察并比较两组血肿扩大的发生率。结果治疗组患者舌下含服卡托普利后15min起效,60min时MAP均降至≤130mmHg,并维持稳定,与对照组比较差异有显著性(P<0.05～0.01)。治疗组血肿扩大的发生率8.3%,对照组22.9%,两组比较差异有显著性(P<0.01)。结论舌下含服卡托普利控制高血压脑出血患者发病后24h内的血压可防止其血肿扩大,舌下含服卡托普利安全有效。     

脑出血继续出血患者血液纤溶活性的研究

目的探讨脑出血（ICH）继续出血与血液纤溶活性的关系。方法将107例ICH患者根据病情分为继续出血组（21例）和非继续出血组（86例）,利用发色底物法及酶联免疫吸附试验双抗体夹心法分别测定两组患者在发病后0-3d、4-9d、14-21d时血浆中组织型纤溶酶原激活物活性（tPAA）、纤溶酶原抑制物活性（PAIA）、纤溶酶原抑制物-1（PAI-1）及D-二聚体（D-D）的水平,并与同期健康体检者进行比较。结果ICH患者发病后0-3d及4-9d血中tPAA显著低于正常对照组（P〈0.05-0.01）,至14-21d与正常对照组差异无统计学意义;ICH后0-3d及4-9d血中PAIA及D-D显著高于正常对照组（P〈0.05-0.01）,至14-21d与正常对照组差异无统计学意义;ICH各期血中PAI-1水平与正常对照组差异无统计学意义;未继续出血组与继续出血组各期各纤溶指标间差异无统计学意义。结论ICH后血中不存在原发性纤溶活性亢进,ICH继续出血与血液纤溶活性无关。     

高血压性脑出血血肿扩大相关因素分析

目的探讨高血压性脑出血后血肿继续扩大的相关因素。方法回顾性分析187例高血压性脑出血病例的临床资料,其中56例出现血肿持续扩大,将其与未出现血肿扩大者进行对比分析。结果①单因素logistic回归分析显示高血压病程、长期饮酒、糖尿病史、长期服用阿司匹林、体重指数高、发病至第一次CT时间短(<2h)、丘脑出血、血肿形态不规则、入院时血压值高、高血糖和早期大量使用甘露醇是高血压性脑出血后血肿扩大的危险因素;②多因素logistic回归分析显示长期饮酒、长期服用阿司匹林、发病至第一次CT时间短(<2h)、丘脑出血、血肿形态不规则、入院时血压值高和早期大量使用甘露醇是高血压性脑出血血肿扩大的独立危险因素。结论对长期饮酒、长期服用阿司匹林、丘脑出血、血肿形态不规则、入院时血压值高以及出血后大量使用甘露醇的高血压性脑出血患者要严密观察病情变化,高度警惕血肿继续扩大以免延误治疗。     

Electrocardiogram changes during hematoma enlargement in intracerebral hemorrhage patients**☆

BACKGROUND： It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE： To investigate changes in electrocardiogram results in patients with intracerebral bematoma enlargement. DESIGN, TIME AND SETTING： The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS： A total of 225 intracerebral hemorrhage patients （142 males and 83 females） that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confirmed using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS： According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement （n = 20） and non-hematoma enlargement （n = 205） groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES： The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS： In the hematoma enlargement group, 15 patients （79%） developed electrocardiographic abnormafities. In the non-hematoma enlargement group, 24 patients （43%） presented with electrocardiographic abnormalities. There were sig     

Electrocardiogram changes during hematoma enlargement in intracerebral hemorrhage patients

BACKGROUND: It has been reported that cerebrovascular disease causes changes in electrocardiogram results. OBJECTIVE: To investigate changes in electrocardiogram results in patients with intracerebral hematoma enlargement. DESIGN, TIME AND SETTING: The present case-retrospective analysis study was performed at the Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology from January 2005 to October 2006. PARTICIPANTS: A total of 225 intracerebral hemorrhage patients (142 males and 83 females) that were hospitalized at the Department of Neurology were enrolled the present study. The patient selection was in accordance with diagnostic criteria from the Fourth National Cerebrovascular Disease Congress of China in 1995, and diagnosis was confLrrned using computed tomography. All patients underwent computed tomography twice within 24 hours following intracerebral hemorrhage, and were subjected to electrocardiogram examination after admission. METHODS: According to hematoma enlargement following intracerebral hemorrhage, all patients were divided into hematoma enlargement (n = 20) and non-hematoma enlargement (n = 205) groups. Because of the large patient number difference between the two groups, the hematoma enlargement group was matched with the non-hematoma enlargement group. Patients meeting these conditions were included in the non-hematoma enlargement group. Finally, 75 patients were included in the final analysis, 19 in the hematoma enlargement group and 56 in the non-hematoma enlargement group. Clinical data from the two groups were statistically analyzed. MAIN OUTCOME MEASURES: The incidence of electrocardiographic abnormalities between the hematoma enlargement and non-hematoma enlargement groups. RESULTS: In the hematoma enlargement group, 15 patients (79%) developed electrocardiographic abnormalities. In the non-hematoma enlargement group, 24 patients (43%) presented with electrocardiographic abnormalities. There were significant differences in electrocardiographic abnormalities between the groups (P < 0.01 ). CONCLUSION: Patients with electrocardiographic abnormalities suffered from hematoma enlargement following admission.     

早期血肿扩大型高血压脑出血30例报告

目的 :探讨高血压脑出血早期血肿扩大的发生原因、危险因素及防治措施 ,以提高该病的诊疗水平 ,减少其死亡率。方法 :分析 30例早期血肿扩大型高血压脑出血病人的临床资料和头颅CT。结果 :早期血肿扩大组(A组 )MAP高于非血肿扩大组 (B组 ) (t=3 6 8,P <0 0 1) ,A组有长期饮酒史 ,血肿形态不规则者多于B组 (χ2 =4 2 2 ;P <0 0 5;χ2 =9 83,P <0 0 1) ,长期服抗凝剂 ,慢性肝病者两组间无差异。结论 :对有血肿扩大可能的高血压脑出血病人 ,要严密观察病情变化 ,及时复查CT ,尽早采取救治措施     

自发性脑出血血肿扩大的影响因素与预后分析

目的探讨自发性脑出血血肿扩大的影响因素,并分析其与预后的关系。 方法选取自2013年12月至2018年12月陕西中医药大学附属医院脑外科收治的670例自发性脑出血患者,根据72 h内复查CT的情况分为血肿扩大组（77例）和血肿稳定组（593例）,记录2组患者的临床资料,分析血肿扩大的影响因素,出院后随访3个月,比较2组患者的预后。 结果670例患者中发生血肿扩大77例,发生率11.49%（77/670）,其中预后不良45例,预后良好32例,血肿稳定组593例,其中预后不良261例,预后良好332例,2组患者预后不良率比较差异有统计学意义（P<0.05）。单因素分析显示,血肿扩大组的活化部分凝血活酶时间、首次CT血肿体积、血肿形态、高血压病、卒中病史与血肿稳定组相比差异有统计学意义（P<0.05）。多因素分析显示,高血压病、卒中病史、血肿形态是自发性脑出血血肿扩大的独立危险因素（OR>1,P<0.05）。 结论自发性脑出血患者出现血肿扩大的独立危险因素包括高血压病、卒中病史、不规则血肿形态,血肿扩大可增加不良预后。