Gebel James M, Jauch Edward C, Brott Thomas G, Khoury Jane, Sauerbeck Laura, Salisbury Shelia, Spilker Judith, Tomsick Thomas A, Duldner John, Broderick Joseph P
University of Pittsburgh Medical Center, Pittsburgh, Pa, USA.
Stroke. 2002 Nov;33(11):2631-5. doi: 10.1161/01.str.0000035284.12699.84.
The natural history of perihematomal edema in human hyperacute spontaneous intracerebral hemorrhage (ICH) has not been well described.
This study was a secondary analysis of a previously reported prospective, population-based study of hematoma growth in 142 patients with spontaneous ICH. Patients were first imaged within 3 hours of onset, then 1 and 20 hours later. We excluded patients with anticoagulant use (n=7), underlying aneurysm/vascular malformation (n=9), trauma (n=1), incomplete data (n=20), infratentorial ICH (n=17), and no consent (n=2), leaving an overall study population of 86 patients. From this overall group we further excluded patients with intraventricular extension (n=38), subsequent surgery (n=5), or death (n=2) before 20-hour postbaseline CT. This second, "restricted" analysis group of 41 patients was relatively devoid of clinical or radiological variables likely to confound edema measurement. Absolute and relative edema volumes (edema volume divided by hematoma volume) were descriptively summarized. Correlations between baseline edema volumes and relevant clinical and radiological variables were then performed.
Overall, median absolute edema volume increased from 6.93 to 14.4 cm(3) during the first 24 hours after ICH, and median relative edema volume increased from 0.47 to 0.81. In the restricted group, median absolute edema volume was 7.4 cm(3) at baseline and 11.0 cm(3) at 24 hours after ICH, and median relative edema volume increased from 0.55 to 0.81. Baseline relative edema volume was significantly negatively correlated with subsequent change in relative edema volume from baseline to 20-hour CT (r=0.57, P=0.0002) but was not significantly correlated with other clinical and radiological variables, including hematoma volume or change in hematoma volume.
Perihematomal edema volume increases by approximately 75% during the first 24 hours after hyperacute spontaneous ICH. Patients with the least amounts of baseline relative edema volume were most likely to develop significant additional amounts of edema during the first 24 hours after spontaneous ICH.
人类超急性自发性脑出血（ICH）血肿周围水肿的自然病程尚未得到充分描述。
本研究是对先前一项已报道的前瞻性、基于人群的142例自发性ICH患者血肿扩大情况研究的二次分析。患者在发病3小时内首次进行影像学检查，然后在1小时和20小时后再次检查。我们排除了使用抗凝剂的患者（n = 7）、潜在动脉瘤/血管畸形患者（n = 9）、外伤患者（n = 1）、数据不完整患者（n = 20）、幕下ICH患者（n = 17）以及未签署知情同意书的患者（n = 2），最终研究总体为86例患者。在这个总体组中，我们进一步排除了在基线CT后20小时内出现脑室扩展的患者（n = 38）、后续接受手术的患者（n = 5）或死亡的患者（n = 2）。这个由41例患者组成的第二个“受限”分析组相对缺乏可能混淆水肿测量的临床或放射学变量。对绝对和相对水肿体积（水肿体积除以血肿体积）进行了描述性总结。然后对基线水肿体积与相关临床和放射学变量之间进行相关性分析。
总体而言，ICH后最初24小时内，绝对水肿体积中位数从6.93增加至14.4 cm³，相对水肿体积中位数从0.47增加至0.81。在受限组中，基线时绝对水肿体积中位数为7.4 cm³，ICH后24小时为11.0 cm³，相对水肿体积中位数从0.55增加至0.81。基线相对水肿体积与从基线到20小时CT时相对水肿体积的后续变化显著负相关（r = 0.57，P = 0.0002），但与其他临床和放射学变量，包括血肿体积或血肿体积变化，无显著相关性。
超急性自发性ICH后最初24小时内，血肿周围水肿体积增加约75%。基线相对水肿体积最少的患者在自发性ICH后最初24小时内最有可能出现显著的额外水肿。
