本文關(guān)鍵詞： 腦出血 早期血腫擴(kuò)大 危險(xiǎn)因素 預(yù)測(cè) 預(yù)后　出處：《瀘州醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討腦出血后早期血腫擴(kuò)大的各種危險(xiǎn)因素及與預(yù)后的相關(guān)性。資料與方法：1、前瞻性登記2012年6月1日-2013年11月1日前往四川省人民醫(yī)院就診的所有神經(jīng)內(nèi)科、神經(jīng)外科的腦出血患者。納入發(fā)病24h以內(nèi)入院接受治療的自發(fā)性腦出血患者，詳細(xì)收集所有與早期血腫擴(kuò)大相關(guān)的指標(biāo)，包括CT影像學(xué)特征、臨床數(shù)據(jù)及實(shí)驗(yàn)室檢查結(jié)果等。所有患者如病情加重立即復(fù)查頭顱CT，病情平穩(wěn)則在發(fā)病72h內(nèi)復(fù)查頭顱CT。復(fù)查頭顱CT結(jié)果與初始CT對(duì)比判斷是否出現(xiàn)早期血腫擴(kuò)大（Hematoma Enlargement，HE），如果血腫體積增大33%或血腫直徑增加10%則視為血腫擴(kuò)大。根據(jù)血腫是否擴(kuò)大，將患者分為血腫擴(kuò)大組（HE）及非血腫擴(kuò)大組（non-HE，NHE）。2、隨訪時(shí)間點(diǎn)為發(fā)病后的3個(gè)月和6個(gè)月，，通過電話或門診進(jìn)行隨訪，主要包括：1）生存狀態(tài)2)有無殘疾。殘疾判定采用改良Rankin評(píng)分量表(Modified Rankin Scale，MRS)。MRS分值3到5分為殘疾，MRS分值0到2分為生活自理。3、計(jì)量資料采用均數(shù)±標(biāo)準(zhǔn)差（x±s）或中位數(shù)描述。兩組計(jì)量資料比較，若數(shù)據(jù)服從正態(tài)分布，采用t檢驗(yàn)；若非正態(tài)分布，采用秩和檢驗(yàn)。計(jì)數(shù)資料采用百分比描述。兩組計(jì)數(shù)資料比較，采用卡方檢驗(yàn)。對(duì)各種危險(xiǎn)因素進(jìn)行單因素分析，確定腦出血后早期血腫擴(kuò)大的危險(xiǎn)因素。單因素分析中P≤0.10者進(jìn)一步多因素分析，排除校正混雜因素，確定血腫擴(kuò)大的獨(dú)立危險(xiǎn)因素。同時(shí)觀察血腫擴(kuò)大對(duì)腦出血患者3月和6月死亡/殘疾的影響。結(jié)果：1、本研究共納入符合標(biāo)準(zhǔn)的病例233例，男性157（67.4%）例，女性76（32.6%）例；年齡范圍為21-92歲；平均年齡61.5±14.3歲；233例患者中，發(fā)生血腫擴(kuò)大者46例（19.7%）；未發(fā)生血腫擴(kuò)大者187例(80.3%)。2、血腫擴(kuò)大多發(fā)生在6h以內(nèi)，血腫擴(kuò)大部位多位于基底節(jié)區(qū)。3、血腫形態(tài)、發(fā)病6h內(nèi)CT檢查兩組間差異有統(tǒng)計(jì)學(xué)意義。多因素回歸分析結(jié)果顯示包括血腫形態(tài)（OR3.125,95%CI1.188～8.215）、發(fā)病6h內(nèi)CT檢查（OR4.862,95%CI1.705～13.862）是自發(fā)性腦出血患者血腫擴(kuò)大的獨(dú)立危險(xiǎn)因素。4、自發(fā)性腦出血后血腫擴(kuò)大加重神經(jīng)功能缺損，是自發(fā)性腦出血預(yù)后不良的獨(dú)立危險(xiǎn)因素。血腫擴(kuò)大（OR9.098,95%CI3.991～20.741）是影響腦出血患者發(fā)病后3月末死亡/殘疾的危險(xiǎn)因素。血腫擴(kuò)大（OR6.844,95%CI2.818～16.626）是影響腦出血患者發(fā)病后6月末死亡/殘疾的危險(xiǎn)因素。結(jié)論：1、自發(fā)性腦出血早期血腫擴(kuò)大的發(fā)生率較高，本研究為19.7%；2、血腫擴(kuò)大的獨(dú)立預(yù)測(cè)因素是血腫形態(tài)和發(fā)病6h內(nèi)CT檢查。血腫形態(tài)越不規(guī)則、發(fā)病至首次CT檢查時(shí)間越短發(fā)生血腫擴(kuò)大的幾率越高；3、血腫擴(kuò)大是腦出血患者3月及6月死亡/殘疾的危險(xiǎn)因素。血腫擴(kuò)大的高�；颊撸瑧�(yīng)積極安排影像學(xué)檢查，及早發(fā)現(xiàn)血腫擴(kuò)大，盡早調(diào)整治療方案。
[Abstract]:Objective: to investigate the risk factors of early hematoma enlargement after intracerebral hemorrhage and its correlation with prognosis. Prospective registration of all neurology departments visiting Sichuan Provincial people's Hospital from June 1st 2012 to November 1st 2013. Patients with intracerebral hemorrhage in neurosurgery. Included in patients with spontaneous intracerebral hemorrhage who were admitted to hospital within 24 hours after the onset of the disease, and collected all the indicators related to the enlargement of early hematoma, including CT imaging features. Clinical data and laboratory results. All patients with exacerbation of the disease immediately review the skull CT. The stable state of the disease was followed up within 72 hours after the onset of the disease. The results of CT were compared with those of the initial CT to determine whether there was early hematoma enlargement and hematoma Enlargement. If the hematoma volume increases by 33% or the hematoma diameter increases by 10%, the hematoma is deemed to be enlarged, depending on whether the hematoma is enlarged or not. The patients were divided into hematoma enlargement group and non-hematoma enlargement group. The follow-up time was 3 months and 6 months after onset, and followed up by telephone or outpatient. The main results were as follows: 1) living state 2) disability. The modified Rankin score scale was used to determine disability with modified Rankin Scale. MRS).MRS scores of 3 to 5 were divided into disability Mrs score 0 to 2 as self-care of living. The metrological data were described by mean 鹵standard deviation (x 鹵s) or median. The two groups were compared with each other. If the data is from normal distribution, t test is used. If it is not normal distribution, rank sum test is used. The counting data is described by percentage. Two groups of counting data are compared and chi-square test is used to analyze all kinds of risk factors. To determine the risk factors of early hematoma enlargement after intracerebral hemorrhage. In univariate analysis, P 鈮

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