Ryu Jeong-Am, Lee Daesang, Yang Jeong Hoon, Chung Chi-Ryang, Park Chi-Min, Suh Gee Young, Jeon Kyeongman
Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Support Care Cancer. 2016 Jul;24(7):2971-8. doi: 10.1007/s00520-016-3094-5. Epub 2016 Feb 11.
Limited data are available on the intracranial haemorrhage (ICH) developed in critically ill cancer patients during their stay in the intensive care unit (ICU).
All consecutive patients who underwent brain CT for suspicion of spontaneous intracerebral haemorrhage (ICH) with acute neurologic symptoms or signs developed during their ICU stay were retrospectively evaluated to identify predictors of ICH.
Over the study period, a total of 273 patients underwent brain CT scanning for suspicion of ICH, with altered mentality in 202 (74 %), seizure in 43 (16 %), and hemiparesis in 34 (13 %). However, only 49 (18 %) patients had a final diagnosis of ICH. The most common type of haemorrhage was intracerebral in 34 patients (69 %), followed by subarachnoidal haemorrhage in 17 (35 %). In multiple logistic regression analysis, anisocoric pupils or abnormal pupil reflex (adjusted OR 7.939; 95 % CI, 2.315-27.228) was an independent predictor of ICH. In addition, higher positive end-expiratory pressure (adjusted OR 1.204; 95 % CI, 1.065-1.361) was significantly associated with ICH. However, platelet count was inversely associated with ICH (adjusted OR 0.993; 95 % CI 0.988-0.999).
Brain CT scanning should be performed even in critically ill cancer patients, especially with risk factors and acute neurologic changes.
关于重症癌症患者在重症监护病房（ICU）期间发生颅内出血（ICH）的数据有限。
对所有因怀疑自发性脑出血（ICH）且在ICU住院期间出现急性神经症状或体征而接受脑部CT检查的连续患者进行回顾性评估，以确定ICH的预测因素。
在研究期间，共有273例患者因怀疑ICH而接受脑部CT扫描，其中202例（74%）意识改变，43例（16%）癫痫发作，34例（13%）偏瘫。然而，最终确诊为ICH的患者仅49例（18%）。最常见的出血类型是脑内出血34例（69%），其次是蛛网膜下腔出血17例（35%）。在多因素逻辑回归分析中，瞳孔不等大或异常瞳孔反射（校正比值比7.939；95%可信区间，2.315 - 27.228）是ICH的独立预测因素。此外，较高的呼气末正压（校正比值比1.204；95%可信区间，1.065 - 1.361）与ICH显著相关。然而，血小板计数与ICH呈负相关（校正比值比0.993；95%可信区间0.988 - 0.999）。
即使是重症癌症患者，尤其是有危险因素和急性神经变化的患者，也应进行脑部CT扫描。
