Department of Neurological Surgery, The Neurological Institute, Columbia University College of Physicians and Surgeons, New York, New York 10032, USA.
J Neurol Neurosurg Psychiatry. 2013 May;84(5):488-93. doi: 10.1136/jnnp-2012-303160. Epub 2013 Jan 23.
It is still unknown whether subsequent perihaematomal oedema (PHE) formation further increases the odds of an unfavourable outcome.
Demographic, clinical, radiographic and outcome data were prospectively collected in a single large academic centre. A multiple logistic regression model was then developed to determine the effect of admission oedema volume on outcome.
133 patients were analysed in this study. While there was no significant association between relative PHE volume and discharge outcome (p=0.713), a strong relationship was observed between absolute PHE volume and discharge outcome (p=0.009). In a multivariate model incorporating known predictors of outcome, as well as other factors found to be significant in our univariate analysis, absolute PHE volume remained a significant predictor of poor outcome only in patients with intracerebral haemorrhage (ICH) volumes ≤30 cm(3) (OR 1.123, 95% CI 1.021 to 1.273, p=0.034). An increase in absolute PHE volume of 10 cm(3) in these patients was found to increase the odds of poor outcome on discharge by a factor of 3.19.
Our findings suggest that the effect of absolute PHE volume on functional outcome following ICH is dependent on haematoma size, with only patients with smaller haemorrhages exhibiting poorer outcome with worse PHE. Further studies are needed to define the precise role of PHE in driving outcome following ICH.
目前尚不清楚血肿周围水肿（PHE）的后续形成是否会进一步增加不良预后的几率。
在一个单一的大型学术中心，前瞻性地收集了人口统计学、临床、影像学和预后数据。然后建立了一个多因素逻辑回归模型，以确定入院时水肿体积对预后的影响。
本研究分析了 133 例患者。虽然相对 PHE 体积与出院结局之间无显著相关性（p=0.713），但绝对 PHE 体积与出院结局之间存在很强的相关性（p=0.009）。在一个包含已知预后预测因素以及我们单因素分析中发现的其他有意义因素的多变量模型中，只有在颅内血肿（ICH）体积≤30cm3 的患者中，绝对 PHE 体积仍然是不良预后的显著预测因素（OR 1.123，95%CI 1.021 至 1.273，p=0.034）。这些患者的绝对 PHE 体积增加 10cm3 ，出院时不良预后的几率增加 3.19 倍。
我们的发现表明，绝对 PHE 体积对 ICH 后功能预后的影响取决于血肿大小，只有血肿较小的患者表现出更差的 PHE 和更差的预后。需要进一步的研究来确定 PHE 在驱动 ICH 后结局中的的确切作用。
