重症监护病房中的脑出血：早期预后谬误。一项单中心回顾性研究。

Intracerebral hemorrhage in Intensive Care Unit: early prognostication fallacies. A single center retrospective study.

机构信息

School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy.

Neurointensive Care, Department of Emergency and Intensive Care, San Gerardo Hospital, ASST-Monza, Italy.

出版信息

Minerva Anestesiol. 2018 May;84(5):572-581. doi: 10.23736/S0375-9393.17.12225-X. Epub 2017 Nov 6.

DOI:10.23736/S0375-9393.17.12225-X

PMID:29108406

Abstract

BACKGROUND

Intracerebral hemorrhage (ICH) admitted to Intensive Care is deem of poor prognosis. The aim of this study was to compare observed and predicted 30-day mortality and to evaluate long term functional outcome in a consecutive ICH cohort.

METHODS

Retrospective analysis of prospectively collected data of ICH patients managed in a Neuro-ICU from 2012 to 2015.

RESULTS

Out of 136 consecutive patients, 34 (25%) had "withholding of life-sustaining treatment" (WLST) order and 102 (75%) received a "full treatment" (FT). WLST cohort: median (IQR): 72 (70-77) years old, Glasgow Coma Scale (GCS) 4 (3-4) at admission, ICH volume 114 cm3 (68-152); all patients died during neuro-ICU recovery, 28 (82%) patients had brain death diagnosis and 15 (54%) of these were organ donors. FT cohort: 67 (51-73) years old, GCS 9 (6-12) at admission, ICH volume 46 (24-90) cm3, neurosurgery for clot removal in 65 (64%) (P<0.05 vs. WLST cohort for each of previously listed variables); 13 (13%) patients died during neuro-ICU recovery, of these 11 (85%) patients had brain death diagnosis and 4 (36%) of them were organ donors. Overall 30-day observed mortality for FT group was 18% (95% CI: 11-26%). Patients with ICH Score 1, 2, 3, 4+ had 0%, 10%, 16% and 26% 30-day mortality, respectively (P<0.01 vs. ICH Score). Full treatment group 180-day mortality was 32% (95% CI: 24-42%). Modified Rankin Scale (mRS) after one year was ≤3 in 35 (35%), i.e. good recovery, and >3 in 64 (65%). Neurosurgery for clot removal was associated with a lower 30 and 180-day mortality (P=0.01 and P=0.03, respectively) and along with GCS at admission it was an independent significant prognostic factor.

CONCLUSIONS

Mortality and functional outcome is less severe than predicted in patients with ICH receiving a full medical and/or surgical treatment.

摘要

背景

脑出血（ICH）患者入住重症监护病房被认为预后不良。本研究旨在比较观察到的和预测的 30 天死亡率，并评估连续 ICH 队列的长期功能结局。

方法

回顾性分析 2012 年至 2015 年神经重症监护病房收治的 ICH 患者的前瞻性数据。

结果

136 例连续患者中，34 例（25%）有“停止维持生命治疗”（WLST）医嘱，102 例（75%）接受“充分治疗”（FT）。WLST 队列：中位（IQR）：72（70-77）岁，入院时格拉斯哥昏迷量表（GCS）4（3-4），ICH 体积 114cm3（68-152）；所有患者在神经重症监护病房恢复期间死亡，28 例（82%）患者诊断为脑死亡，其中 15 例（54%）为器官捐献者。FT 队列：67（51-73）岁，入院时 GCS 9（6-12），ICH 体积 46（24-90）cm3，65 例（64%）行血肿清除术（与 WLST 队列相比，每个变量均为 P<0.05）；13 例（13%）患者在神经重症监护病房恢复期间死亡，其中 11 例（85%）患者诊断为脑死亡，其中 4 例（36%）为器官捐献者。FT 组总体 30 天观察死亡率为 18%（95%CI：11-26%）。ICH 评分 1、2、3、4+的患者 30 天死亡率分别为 0%、10%、16%和 26%（P<0.01 与 ICH 评分）。FT 组 180 天死亡率为 32%（95%CI：24-42%）。一年后改良 Rankin 量表（mRS）≤3 者为 35 例（35%），即恢复良好，>3 者为 64 例（65%）。血肿清除术与 30 天和 180 天死亡率降低相关（P=0.01 和 P=0.03），与入院时 GCS 一起是独立的显著预后因素。