Diringer M N, Edwards D F, Zazulia A R
Department of Neurology, Washington University School of Medicine, St Louis, MO 63110, USA.
Stroke. 1998 Jul;29(7):1352-7. doi: 10.1161/01.str.29.7.1352.
Although several factors have been identified that predict outcome after intracerebral hemorrhage (ICH), no previous study has investigated the impact of hydrocephalus. The purpose of this study was to determine whether the presence of hydrocephalus after ICH would predict mortality and functional outcome.
Patients with spontaneous supratentorial ICH were identified in our prospectively collected database to determine the following: age, sex, race, past medical history; Glasgow Coma Scale (GCS) score and blood pressure on admission; use of mechanical ventilation, mannitol, and ventriculostomy; and medical complications. CT scans performed within 24 hours of hemorrhage were retrospectively analyzed to determine lesion size and location, pineal shift, cisternal effacement, intraventricular hemorrhage (IVH), and hydrocephalus. Outcome was determined with use of hospital disposition (dead, nursing home, rehabilitation, home) and functional outcome (Functional Independence Measure [FIM]) at 3 months. Patients with and without hydrocephalus were compared and univariate and multivariate analyses performed to determine whether hydrocephalus was an independent predictor of mortality. Data are presented as mean+/-SD.
Of the 81 patients studied, 40 had hydrocephalus. Those with hydrocephalus were younger (57+/-15 versus 67+/-15 years), had lower GCS scores (8.2+/-4.2 versus 11+/-2.9), were more likely to have ganglionic or thalamic hemorrhages, and were intubated more frequently (70% versus 27%). Hospital mortality was higher in patients with hydrocephalus (51% versus 2%), and fewer patients went home (21% versus 35%). Those who died had higher hydrocephalus scores (9.67+/-7.1 versus 5.75+/-4.5). Outcome was no different if a ventriculostomy was placed. The final logistic regression model included hydrocephalus score, gender, GCS, and pineal shift, and it correctly predicted 85% of patients as dead or alive. Multivariate analyses indicated that hydrocephalus is an independent predictor of mortality.
We conclude that hydrocephalus is an independent predictor of mortality after ICH.
尽管已确定多种预测脑出血（ICH）后预后的因素，但此前尚无研究探讨脑积水的影响。本研究的目的是确定脑出血后脑积水的存在是否会预测死亡率和功能结局。
在我们前瞻性收集的数据库中识别自发性幕上脑出血患者，以确定以下内容：年龄、性别、种族、既往病史；入院时的格拉斯哥昏迷量表（GCS）评分和血压；机械通气、甘露醇和脑室造瘘术的使用情况；以及医疗并发症。对出血后24小时内进行的CT扫描进行回顾性分析，以确定病变大小和位置、松果体移位、脑池消失、脑室内出血（IVH）和脑积水情况。结局通过医院处置情况（死亡、养老院、康复、回家）和3个月时的功能结局（功能独立性测量[FIM]）来确定。比较有和没有脑积水的患者，并进行单因素和多因素分析，以确定脑积水是否为死亡率的独立预测因素。数据以均值±标准差表示。
在研究的81例患者中，40例有脑积水。有脑积水的患者更年轻（57±15岁对67±15岁），GCS评分更低（8.2±4.2对11±2.9），更有可能发生神经节或丘脑出血，且插管频率更高（70%对27%）。有脑积水的患者医院死亡率更高（51%对2%），回家的患者更少（21%对35%）。死亡患者的脑积水评分更高（9.67±7.1对5.75±4.5）。放置脑室造瘘管后的结局无差异。最终的逻辑回归模型包括脑积水评分、性别、GCS和松果体移位，它正确预测了85%的患者死亡或存活。多因素分析表明脑积水是死亡率的独立预测因素。
我们得出结论，脑积水是脑出血后死亡率的独立预测因素。
