高血压性脑出血早期血肿扩大的临床研究

目的 :探讨高血压性脑出血早期血肿扩大的相关因素及其对预后的影响和防治对策。方法 :对 13 8例高血压性幕上性脑出血患者发病早期行脑CT检查 ,4 8h复查。血肿体积增大 3 3 %为早期血肿扩大。对血肿扩大发生的时间规律及其与相关因素的关系和对病情的影响进行单、多因素分析。结果 :早期血肿扩大 4 9例 (A)组 ,未扩大 89例 (B组 )。无论单、多因素分析 ,A组发病 <6h做首次CT与B组相应时间做首次CT的例数比较 ,差异非常显著 (P <0 .0 1) ;A组血肿体积、形态不规则及合并肾功能不全者 ,皆明显大于或多于B组 ,差异非常显著 (P均 <0 .0 1) ;合并糖尿病、入院时收缩压水平、酗酒及颅压增高不突出发病 2 4h内应用甘露醇对早期血肿扩大的影响 ,仅单因素分析有统计学差异 (P <0 .0 1或P <0 .0 5 )。A组复查CT时神经功能缺损积分明显增加 (P <0 .0 1) ,两组死亡率差异极显著 (P <0 .0 1)。结论 :高血压性脑出血早期血肿扩大于发病 6h内最多见 ,>2 4h者较少见。首次CT时间、血肿体积和形态、肾功能状况是高血压性脑出血早期血肿扩大的重要影响因素 ;合并糖尿病、收缩压过高、酗酒及早期不适当应用甘露醇与早期血肿扩大亦有关。

Clinical Study on Early Enlargement of Hematoma in Hypertensive Cerebral Hemorrhage

Objective: To study the correlation factors and their influence on prognosis for early enlargement of hematoma in hypertensive cer ebral hemorrhage. Methods: 138 cases with hypertensive supratentorial cerebral hem orrhage were examined by cranial CT at the early stage, and reexamined 48h later . If the volume of hematoma increased by 33%, it was named as early enlargement of hematoma. The correlation factors and their influence on the disease were analyzed by single and logistic analysis. Results: 49 cases had early enlargement of hematoma ( Group A) and 89 cases had no enlargement (Group B). By both single and log istic analysis, there was significant differance between Growp A and B, in CT performed at<6h after the onset (P<0.01); the volume of hematoma and hematoma irregular in shape and renal insufficiency in Group A were much more than in Group B. But patients with abuse and systolic pressure in Group A were much more than those in Group B ((P<0.05) only by single analysis. There were differences between the patients treated with or without mannitol when hematoma<30ml, light intracranial hypertension and onset withi n 24h in the(P<0.01). When CT was redone in Group A, integral of nerve function defect increased markedly (P<0.05). There was significant difference between the death rates in two groups (P<0.01). Conclusion: In hypertensive cerbral hemorrhage, early enlargenen t of hematoma is most common within 6h after the onset and less common 24h later . The earlier CT, larger volume of hematoma, hematoma irregular in sha pe, and renal insufficiency are most important factors of hematoma, and it still relates to higher systolic presure, alcoholic abuse, diabetes and the ear ly unreasonable use of mannitol. Enlargement of hematoma worsens patient's condi tion and increases death rate.