Yu Zhiyuan, Zheng Jun, Guo Rui, Ma Lu, Li Mou, Wang Xiaoze, Lin Sen, You Chao, Li Hao
Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
World Neurosurg. 2018 Jan;109:e651-e654. doi: 10.1016/j.wneu.2017.10.049. Epub 2017 Oct 17.
To investigate the association between ultraearly hematoma growth (uHG) and clinical outcome in patients with spontaneous intracerebral hemorrhage (sICH) receiving hematoma evacuation.
Supratentorial sICH patients receiving hematoma evacuation within 24 hours after ictus were enrolled in this study. uHG was defined as baseline hematoma volume/onset-to-computed tomography (CT) time (mL/h). The outcome was assessed by the modified Rankin Scale (mRS) score at 3 months. Unfavorable outcome was defined as mRS >2.
A total of 93 patients were enrolled in this study. The mean uHG was 10.3 ± 5.5 mL/h. In 69 (74.2%) of patients, the outcome was unfavorable at 3 months. The uHG in patients with unfavorable outcome were significantly higher than in those with favorable outcome (11.0 ± 6.1 mL/h vs. 8.3 ± 2.5 mL/h, P = 0.003). The optimal cutoff of uHG for predicting unfavorable outcome was 8.7 mL/h. The sensitivity, specificity, positive predictive value, and negative predictive value of uHG >8.7 mL/h for predicting unfavorable outcome were 56.5%, 75.0%, 86.7%, and 37.5%, respectively.
uHG is a helpful predictor of unfavorable outcome in sICH patients treated with hematoma evacuation. The optimal cutoff of uHG to assist in predicting unfavorable outcome in sICH patients receiving hematoma evacuation is 8.7mL/h.
探讨自发性脑出血（sICH）患者接受血肿清除术后超早期血肿增长（uHG）与临床结局之间的关联。
纳入发病后24小时内接受血肿清除术的幕上sICH患者。uHG定义为基线血肿体积/发病至计算机断层扫描（CT）时间（mL/h）。结局通过3个月时的改良Rankin量表（mRS）评分进行评估。不良结局定义为mRS>2。
本研究共纳入93例患者。平均uHG为10.3±5.5 mL/h。69例（74.2%）患者在3个月时结局不良。结局不良患者的uHG显著高于结局良好患者（11.0±6.1 mL/h对8.3±2.5 mL/h，P = 0.003）。预测不良结局的uHG最佳截断值为8.7 mL/h。uHG>8.7 mL/h预测不良结局的敏感性、特异性、阳性预测值和阴性预测值分别为56.5%、75.0%、86.7%和37.5%。
uHG是接受血肿清除术的sICH患者不良结局的一个有用预测指标。辅助预测接受血肿清除术的sICH患者不良结局的uHG最佳截断值为8.7mL/h。
