自发性脑出血血肿扩大的预测：我们的机构经验。

Prediction of hematoma expansion in spontaneous intracerebral hemorrhage: Our institutional experience.

机构信息

Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, PA, United States.

出版信息

J Clin Neurosci. 2021 Apr;86:271-275. doi: 10.1016/j.jocn.2021.01.046. Epub 2021 Feb 19.

DOI:10.1016/j.jocn.2021.01.046

PMID:33775341

Abstract

BACKGROUND

Spontaneous intracerebral hemorrhage (sICH) is a disease process with high morbidity and mortality. In particular, hematoma expansion (HE) is a feared complication of sICH. With 15-40% of patients experiencing HE, it has become increasingly important to predict which sICH will remain stable and which will expand.

OBJECTIVE

With new treatment options being developed, it is becoming increasingly important to be able to predict which hemorrhages are at high versus low risk for expansion. The authors of this study hope to reexamine variables associated with hematoma expansion in hopes of generating newer data on risk factors for expansion.

METHODS

A retrospective analysis identified 334 patients who presented with sICH. The primary outcome was HE on follow up head CT. HE was defined as a greater than 33% increase or an absolute increase in 6 mL or more in overall volume between the two sets of CT images. Analysis was performed using unpaired t-test, Chi-square, and Fisher's exact tests, as appropriate.

RESULTS

Of the 334 patients, 247 (74.0%) did not experience an expansion of their ICH while 87 (26.0%) did. Multivariable logistic regression was performed demonstrating ICH score of 3 or greater (4.76 (95% CI 2.60-8.72, p < 0.001) , cortical location of the sICH (1.77 (95% CI 1.03-3.04, p = 0.038), and presence of a fluid level (6.46 (95% CI 2.28-18.3, p < 0.001) as significant predictors of HE.

CONCLUSIONS

Our study found that fluid-fluid levels on non-contrast CT, an ICH score 3 or greater, and lobar sICH were all more likely to expand.

摘要

背景

自发性脑出血（sICH）是一种发病率和死亡率都很高的疾病。特别是，血肿扩大（HE）是 sICH 的一种可怕并发症。有 15-40%的患者会出现 HE，因此预测哪些 sICH 会保持稳定，哪些会扩大变得越来越重要。

目的

随着新的治疗方法的不断发展，能够预测哪些出血具有较高或较低的扩大风险变得越来越重要。本研究的作者希望重新检查与血肿扩大相关的变量，以期生成关于扩大风险因素的最新数据。

方法

一项回顾性分析确定了 334 名患有 sICH 的患者。主要结局是随访头部 CT 上的 HE。HE 定义为两次 CT 图像之间总体体积增加大于 33%或绝对值增加 6ml 或更多。分析使用配对 t 检验、卡方检验和 Fisher 精确检验，视情况而定。

结果

在 334 名患者中，247 名（74.0%）患者的 ICH 未扩大，87 名（26.0%）患者的 ICH 扩大。多变量逻辑回归显示 ICH 评分 3 或更高（4.76（95%CI 2.60-8.72，p<0.001）、皮质位置的 sICH（1.77（95%CI 1.03-3.04，p=0.038）和存在液平（6.46（95%CI 2.28-18.3，p<0.001）是 HE 的显著预测因素。