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自发性脑出血急性期血肿扩大的危险因素分析及对预后的影响 被引量:2

Risk factors for hematoma expansion during the acute phase of spontaneous intracerebral hemorrhage and its impact on prognosis
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摘要 目的探讨自发性脑出血患者急性期血肿扩大的危险因素及对预后的影响。方法选取2018年9月至2019年10月于西京医院就诊自发性脑出血的患者146例,根据CT检查结果分为血肿扩大组40例和非血肿扩大组106例。比较两组患者一般临床资料、神经功能评分和CT检查结果等,将差异显著的因素纳入Logistic多因素回归分析,以血肿扩大的独立危险因素构建自发性脑出血患者血肿扩大风险预测Nomogram模型,用校准曲线和决策曲线对模型进行评价。根据患者出院后90 d的随访结果分析比较血肿扩大组和非血肿扩大组的预后情况。结果血肿扩大组患者收缩压、美国国立卫生研究院卒中量表(NIHSS)评分、血糖水平高于非血肿扩大组,发病距初诊的CT时间、格拉斯哥昏迷指数(GCS)评分、超敏C反应蛋白(hs-CRP)低于非血肿扩大组,出现岛征、混合征和黑洞征的人群比例高于非血肿扩大组,差异具有统计学意义(t/χ^(2)=1.991、5.569、3.991、2.554、5.330、2.087、9.226、6.291、23.639,均P<0.05)。多因素分析结果显示发病距初诊CT时间、NIHSS评分、出现岛征、混合征和黑洞征为自发性脑出血急性期血肿扩大的独立危险因素[OR(95%CI)=0.304(0.120~0.769)、6.408(2.458~16.706)、3.746(1.545~9.084)、4.719(0.886~15.126)、11.433(1.453~18.946),均P<0.05]。校准曲线显示上述因素构建的血肿扩大发生风险Nomogram模型准确性较高,决策曲线显示其具有良好的临床实用性。生存曲线分析显示血肿扩大组患者预后情况较非血肿扩大组患者差(χ^(2)=32.195,P<0.05)。结论发病距初诊CT时间、NIHSS评分、岛征、混合征和黑洞征是自发性脑出血患者急性期血肿扩大的危险因素,根据上述因素构建的Nomogram预测模型对血肿扩大发生风险预测效能较好。 Objective To explore the risk factors for hematoma expansion during the acute phase of patients with spontaneous intracerebral hemorrhage(sICH)and its impact on prognosis.Methods A total of 146 patients with sICH in Xijing Hospital from September 2018 to October 2019 were selected and divided into the hematoma expansion group(40 cases)and non-hematoma expansion group(106 cases)based on the results of CT examination.The general clinical data,neurological function scores and CT examination results of the two groups were compared.Factors with significant differences were included in the multivariate Logistic regression analysis.The independent risk factors for hematoma expansion were used to construct a Nomogram model predicting the risk of hematoma expansion in patients with sICH.Calibration and decision curves were used to evaluate the model.The prognosis of patients in the hematoma expansion group and non-hematoma expansion group was analyzed and compared based on the 90-day follow-up results after discharge.Results The systolic blood pressure(SBP),National Institutes of Health Stroke Scale(NIHSS)score and blood glucose level of patients in the hematoma expansion group were higher than those in the non-hematoma expansion group,while the CT time from onset,Glasgow Coma Scale(GCS)score,and the level of high-sensitivity C-reactive protein(hs-CRP)were lower than those in the non-hematoma expansion group,and the proportions of patients with island sign,blend sign,and black hole sign were higher than those in the non-hematoma expansion group,all with statistically significant differences(t/χ^(2)=1.991,5.569,3.991,2.554,5.330,2.087,9.226,6.291,23.639;P<0.05).The results of multivariate analysis showed that the CT time from onset,NIHSS score,and the presence of island sign,blend sign and black hole sign were independent risk factors for hematoma expansion during the acute phase of spontaneous cerebral hemorrhage[OR(95%CI)=0.304(0.120-0.769),6.408(2.458-16.706),3.746(1.545-9.084),4.719(0.886-15.126),11.433(1.453-18.946);
作者 李培 单尼奇 赵鹏 Li Pei;Shan Niqi;Zhao Peng(Department of Emergency,Xijing Hospital,Xi'an 710032,China)
出处 《心脑血管病防治》 2023年第10期15-19,共5页 CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT
关键词 自发性脑出血 血肿扩大 危险因素 预后 Spontaneous intracerebral hemorrhage Hematoma expansion Risk factors Prognosis
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