Martí-Fàbregas J, Belvís R, Guardia E, Cocho D, Muñoz J, Marruecos L, Martí-Vilalta J-L
Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.
Neurology. 2003 Oct 28;61(8):1051-6. doi: 10.1212/01.wnl.0000090520.67254.14.
To investigate whether data obtained by transcranial Doppler (TCD) have prognostic value in patients with intracerebral hemorrhage (ICH).
A prospective study of patients with an acute (<12 hours from onset of symptoms) spontaneous supratentorial ICH was conducted. Mortality was assessed at 30-day follow-up. TCD parameters were obtained from both middle cerebral arteries: systolic, diastolic, and mean velocities and Pulsatility Index (PI) from the affected and unaffected hemispheres. The following variables were included in a univariate analysis: age, sex, hematoma volume, hypodense volume around the hematoma, total volume, midline shift, ventricular size, Glasgow Coma Scale score, intraventricular hemorrhage, body temperature, white cell count, blood glucose, mean blood pressure, and TCD data. A multivariate analysis was performed with variables that showed significance in the univariate analysis. Receiver-operator characteristic (ROC) curves were obtained.
Forty-eight patients (age 66.5 +/- 12.5 years; 28 men) were studied. Mortality at 30 days was 31%. The only predictor of mortality was the Glasgow Coma Scale score (odds ratio [OR] 0.67, CI 0.53 to 0.84, p = 0.001), whereas the PI from the unaffected hemisphere was correlated with mortality (OR 2.3, CI 0.92 to 5.72, p = 0.07). The area under the ROC curve was 0.92. A cutoff for PI from the unaffected hemisphere of 1.75 showed a specificity of 94% and a sensitivity of 80% as a predictor of death at 30 days.
The PI of the unaffected hemisphere may be a predictor of death in acute ICH. These findings suggest that intracranial hypertension is the most likely cause of death in most patients with ICH.
探讨经颅多普勒（TCD）所获数据对脑出血（ICH）患者是否具有预后价值。
对急性（症状发作<12小时）自发性幕上ICH患者进行前瞻性研究。在30天随访时评估死亡率。从双侧大脑中动脉获取TCD参数：收缩期、舒张期和平均流速以及患侧和健侧半球的搏动指数（PI）。单因素分析纳入以下变量：年龄、性别、血肿体积、血肿周围低密度体积、总体积、中线移位、脑室大小、格拉斯哥昏迷量表评分、脑室内出血、体温、白细胞计数、血糖、平均血压以及TCD数据。对在单因素分析中显示有意义的变量进行多因素分析。绘制受试者工作特征（ROC）曲线。
共研究了48例患者（年龄66.5±12.5岁；男性28例）。30天死亡率为31%。死亡率的唯一预测因素是格拉斯哥昏迷量表评分（比值比[OR]0.67，可信区间[CI]0.53至0.84，p = 0.001），而健侧半球的PI与死亡率相关（OR 2.3，CI 0.92至5.72，p = 0.07）。ROC曲线下面积为0.92。健侧半球PI的截断值为1.75时，作为30天死亡预测指标的特异性为94%，敏感性为80%。
健侧半球的PI可能是急性ICH患者死亡的预测指标。这些发现提示颅内高压是大多数ICH患者最可能的死亡原因。
