儿科 ICU 中自发性脑出血的临床转归和预后因素：12 年经验

Clinical Outcomes and Prognostic Factors for Spontaneous Intracerebral Hemorrhage in Pediatric ICU: A 12-Year Experience.

机构信息

Pediatric Intensive Care Unit, Institute of Intensive Care Medicine and Anesthesiology, Catholic University Medical School, Rome, Italy.

Neonatal and Pediatric Intensive Care, Paris Sud Hospital, Paris, France.

出版信息

J Intensive Care Med. 2019 Nov-Dec;34(11-12):1003-1009. doi: 10.1177/0885066617726049. Epub 2017 Aug 29.

DOI:10.1177/0885066617726049

PMID:28847237

Abstract

BACKGROUND

In the pediatric population, spontaneous intracerebral hemorrhage (sICH) is as common as ischemic stroke and accounts for significant mortality and morbidity. Differently from the ischemic stroke, there are few guidelines for directing management of sICH. This article aims to analyze both clinical outcomes and prognostic factors in order to produce tools for the design of prospective randomized studies addressed to implement treatment of pediatric sICH.

METHODS

Twelve-year retrospective review of a single-center consecutivesICH pediatric cases admitted to the pediatric intensive care unit (PICU). Selected end points were survival, PICU stay, and dichotomized Glasgow Outcome Score (GOS), with recovery and moderate disability (GOS 4-5) classified as favorable outcome and vegetative state or severe disability (GOS 2-3) classified as unfavorable.

RESULTS

Data of 107 children younger than 14 years admitted to our PICU due to sICH were analyzed. Overall PICU mortality was 24.2%. On multivariate analysis, the single factor markedly influencing survival was the presence of midline shift ( = .002). In PICU survivors, there were 42 GOS 2-3 and 39 GOS 4-5. A low Glasgow Coma Scale (GCS) on PICU admission was predictive of severe neurological impairment in survivors ( = .003). Intraventricular hemorrhage and infratentorial origin did not influence outcome in this series.

CONCLUSION

The severity of presentation of sICH expressed by the midline shift and the GCS at PICU admission are significant prognostic factors for survival and neurological outcome. Some prognostic factors of the adult population have not been confirmed.

摘要

背景

在儿科人群中，自发性脑出血（sICH）与缺血性脑卒中一样常见，且具有较高的病死率和病残率。与缺血性脑卒中不同，针对 sICH 的管理，目前仅有少数指南可循。本文旨在分析临床转归和预后因素，以便为设计针对小儿 sICH 的前瞻性随机研究提供工具。

方法

回顾性分析了单中心连续收治的入住儿科重症监护病房（PICU）的 12 岁以下 sICH 患儿。选择的终点是生存率、PICU 入住时间和二分 Glasgow 预后评分（GOS），将恢复和中度残疾（GOS 4-5）定义为良好结局，将植物状态或重度残疾（GOS 2-3）定义为不良结局。

结果

共分析了 107 例因 sICH 入住我院 PICU 的年龄小于 14 岁的患儿的数据。总体 PICU 病死率为 24.2%。多因素分析表明，唯一显著影响生存率的因素是中线移位（ =.002）。在 PICU 存活者中，有 42 例 GOS 2-3 和 39 例 GOS 4-5。PICU 入院时格拉斯哥昏迷量表（GCS）较低是存活者严重神经功能障碍的预测因素（ =.003）。在本系列中，脑室出血和幕下起源并未影响预后。