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。

Influencing factors and prognosis of hematoma enlargement in spontaneous cerebral hemorrhage

ObjectiveTo explore the influencing factors of hematoma enlargement in spontaneous cerebral hemorrhage and analyze the relationship with prognosis. MethodsFrom December 2013 to December 2018, 670 patients with spontaneous intracerebral hemorrhage were selected from the Department of Brain Surgery, Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine. According to the reexamination of CT within 72 h, they were divided into hematoma expansion group (77 cases) and hematoma stabilization group (593 cases). The clinical data of the two groups were recorded, the influencing factors of hematoma expansion were analyzed, followed up for 3 months after discharge, and the prognosis of the two groups was compared. ResultsAmong 670 patients, hematoma enlargement occurred in 77 cases, the incidence was 11.49% (77/670), of which 45 had poor prognosis, 32 had good prognosis, 593 had stable hematoma group, 261 had poor prognosis, 332 had good prognosis, the difference between the two groups was statistically significant (P<0.05). Single factor analysis showed that there were significant differences in activated partial thromboplastin time, volume of first CT hematoma, shape of hematoma, history of hypertension and stroke between hematoma expansion group and hematoma stabilization group (P<0.05). Multivariate analysis showed that hypertension, history of stroke and shape of hematoma were independent risk factors for hematoma enlargement of spontaneous cerebral hemorrhage (OR>1, P<0.05). ConclusionThe independent risk factors of hematoma enlargement in patients with spontaneous intracerebral hemorrhage include hypertension, stroke history and irregular hematoma shape.Hematoma enlargement can increase the adverse prognosis.