高血压脑出血患者颅内血肿周围水肿体积扩大的相关影响因素分析
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摘要
目的探讨高血压脑出血患者颅内血肿周围水肿体积扩大的相关影响因素,为临床干预措施的制订提供理论依据。方法本研究选取2015年1月-2017年12月遵义市某医院收治的143例高血压脑出血患者为研究对象。根据患者颅内血肿周围水肿是否扩大分为水肿扩大组(n=68例)和水肿未扩大组(n=75例)。比较2组患者性别构成、年龄、病程、使用药物情况(是否使用氨氯地平、甘露醇及血管紧张素转换酶抑制剂)、血压变异性等一般资料,并探讨高血压脑出血患者颅内血肿周围水肿体积扩大的相关影响因素。结果水肿扩大组中病程≥10d的患者所占比例及血压变异性高的患者所占比例高于水肿未扩大组,而氨氯地平使用率低于水肿未扩大组,差异均有统计学意义(P<0.05)。Logistic多元回归分析结果显示,病程≥10d及血压变异性高是高血压脑出血患者颅内血肿周围水肿体积扩大的危险因素,而使用氨氯地平是高血压脑出血患者颅内血肿周围水肿体积扩大的保护因素(P<0.05)。结论高血压脑出血患者颅内血肿周围水肿体积的扩大受到多种因素的影响,临床上应尽早对高血压脑出血患者进行相关干预,以缩短患者脑出血病程;同时强化血压管理,尤其是使用氨氯地平,以降低患者血压变异性,进而防治血肿周围水肿体积的扩大,改善患者预后。
Objective To investigate the influencing factors of perihematomal edema expansion in patients with hypertensive cerebral hemorrhage,which may provide theoretical evidence for the development of clinical interventions.Methods A total of 143 patients with hypertensive cerebral hemorrhage who were treated at a Zunyi hospital during the period from January 2015 to December 2017 were included in this study.These patients were divided into the edema expansion group(n=68)and the no edema expansion group(n=75).The gender composition,age,duration of disease,use of medications(with or without the use of amlodipine,mannitol,and ACEI),and blood pressure variability were compared between the two groups,and then the influencing factors of perihematomal edema expansion in patients with hypertensive cerebral hemorrhage were assessed.Results The proportions of patients with disease duration≥10 dand those with significant blood pressure variability were higher in the edema expansion group as compared with the no edema expansion group,but the use of amlodipine was less frequent in the edema expansion group(P<0.05).The Logistic multiple regression analysis indicated that,disease duration≥10 dand significant blood pressure variability were risk factors for perihematomal edema expansion in patients with hypertensive cerebral hemorrhage,while use of amlodipine was a protective factor for this(P<0.05).Conclusion In patients with hypertensive cerebral hemorrhage,perihematomal edema expansion may be influenced by several factors.Early intervention is important for these patients,so as to shorten the duration of cerebral hemorrhage;meanwhile blood pressure management should be strengthened,especially the use of amlodipine,which may reduce blood pressure variability and thereby prevent perihematomal edema expansion and improve patient prognosis.
Objective To investigate the influencing factors of perihematomal edema expansion in patients with hypertensive cerebral hemorrhage,which may provide theoretical evidence for the development of clinical interventions.Methods A total of 143 patients with hypertensive cerebral hemorrhage who were treated at a Zunyi hospital during the period from January 2015 to December 2017 were included in this study.These patients were divided into the edema expansion group(n=68)and the no edema expansion group(n=75).The gender composition,age,duration of disease,use of medications(with or without the use of amlodipine,mannitol,and ACEI),and blood pressure variability were compared between the two groups,and then the influencing factors of perihematomal edema expansion in patients with hypertensive cerebral hemorrhage were assessed.Results The proportions of patients with disease duration≥10 dand those with significant blood pressure variability were higher in the edema expansion group as compared with the no edema expansion group,but the use of amlodipine was less frequent in the edema expansion group(P<0.05).The Logistic multiple regression analysis indicated that,disease duration≥10 dand significant blood pressure variability were risk factors for perihematomal edema expansion in patients with hypertensive cerebral hemorrhage,while use of amlodipine was a protective factor for this(P<0.05).Conclusion In patients with hypertensive cerebral hemorrhage,perihematomal edema expansion may be influenced by several factors.Early intervention is important for these patients,so as to shorten the duration of cerebral hemorrhage;meanwhile blood pressure management should be strengthened,especially the use of amlodipine,which may reduce blood pressure variability and thereby prevent perihematomal edema expansion and improve patient prognosis.
引文
[1]朱立仓,赵冬,徐上知,等.新疆地区三个民族3550例高血压性脑出血患者的临床调查[J].中华神经外科杂志,2015,31(9):912-917.DOI:10.3760/cma.j.issn.1001-2346.2015.09.013.
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[3]黄明.早期强化降压对高血压脑出血患者颅内血肿及周围水肿的影响[J].中国实用神经疾病杂志,2017,20(19):55-57.DOI:10.3969/j.issn.1673-5110.2017.19.013.
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[7]QURESHI AI,PALESCH YY,MARTIN R,et al.Effect of systolic blood pressure reduction on hematoma expansion,perihematomal edema,and 3-month outcome among patients with intracerebral hemorrhage:results from the antihypertensive treatment of acute cerebral hemorrhage study[J].Arch Neurol,2010,67(5):570-576.
[8]袁璞,聂文臣.高血压脑出血血肿周围水肿的危险因素分析[J].临床神经外科杂志,2016,13(4):307-309.DOI:10.3969/j.issn.1672-7770.2016.04.018.
[9]魏秀芳,房昕辉,任莉娜,等.自主神经功能对血压变异性的影响[J].国际老年医学杂志,2017,38(3):97-100.DOI:10.3969/j.issn.1674-7593.2017.03.001.
[10]SHI BZ,MENG XF,YANG JX,et al.Effect of erythrocytes on brain water content and haem oxygenase-1 expression in rats with traumatic intracerebral haemorrhage[J].Acta Neurochir(Wien),2012,154(6):1081-1086.DOI:10.1007/s00701-012-1335-z.
[11]刘启云,刘莹莹,韩军丽,等.诊间血压变异性对老年高血压患者血管内皮功能的影响[J].南方医科大学学报,2015,35(9):1320-1324.DOI:10.3969/j.issn.1673-4254.2015.09.021.
[12]DONG M,XI G,KEEP RF,et al.Role of iron in brain lipocalin 2 upregulation after intracerebral hemorrhage in rats[J].Brain Research,2013,1505(6):86-92.DOI:10.1016/j.brainres.2013.02.008.
[13]彭晓晖.脑出血后并发迟发性脑水肿的危险因素分析[J].实用医院临床杂志,2017,14(5):59-61.DOI:10.3969/j.issn.1672-6170.2017.05.019.
[14]丁兴,林海峰.脑出血后脑水肿发病机制研究进展[J].世界最新医学信息文摘,2015,15(86):59-60.DOI:10.3969/j.issn.1671-3141.2015.86.023.
[15]佟冬雪.高血压血肿周围水肿的危险因素分析[J].河北医药,2015,37(18):2841-2844.DOI:10.3969/j.issn.1002-7386.2015.18.043.
[16]杜鹏,哈斯也提·依不来音,木依提·阿不里米提,等.高血压脑出血后血肿增大相关因素分析[J].中华实用诊断与治疗杂志,2016,30(9):875-877.DOI:10.13507/j.issn.1674-3474.2016.09.015.
[17]XIE Q,GU Y,HUA Y,et al.Deferoxamine attenuates white matter injury in a piglet intracerebral hemorrhage model[J].Stroke,2013,45(1):290.DOI:10.1161/STROKEAHA.113.003033.
[18]ROUAULT TA.Iron metabolism in the CNS:implications for neurodegenerative diseases[J].Nature Reviews Neuroscience,2013,14(8):551-564.DOI:10.1038/nrn3453.
[19]付伟,毕东祥,杜文彬,等.铁蛋白在高血压脑出血后血肿周围脑水肿中的作用及机制[J].中国医药导报,2016,13(2):46-49.
[20]LI JY,YUAN LX,ZHANG GM,et al.Activating blood circulation to remove stasis treatment of hypertensive intracerebral hemorrhage:a multi-center prospective randomized open-label blinded-endpoint trial[J].Chinese Journal of Integrative Medicine,2016,22(5):328-334.DOI:10.1007/s11655-016-2467-7.
[21]陈东辉,程宏伟.高血压脑出血术后再出血的多因素分析[J].安徽医科大学学报,2015,50(6):873-876.DOI:10.3969/j.issn.1674-0742.2010.07.078.
[22]王超,游潮,刘窗溪,等.高血压脑出血后血浆及脑脊液IL-1β和IL-6在病情评估中的应用价值[J].中华神经外科杂志,2015,31(11):1158-1160.DOI:10.3760/cma.j.issn.1001-2346.2015.11.019.
[23]YANG G,SHAO GF.Elevated serum IL-11,TNFα,and VEGF expressions contribute to the pathophysiology of hypertensive intracerebral hemorrhage(HICH)[J].Neurological Sciences,2016,37(8):1-7.DOI:10.1007/s10072-016-2576-z.
[24]郝亮,习望,王海燕,等.亚低温治疗对重症高血压脑出血患者血清IL-6及CRP的影响[J].医学临床研究,2015,32(10):1946-1948.DOI:10.3969/j.issn.1671-7171.2015.10.024.
[25]王建国.血清白蛋白与高血压性脑出血血肿周围水肿的相关性分析[J].中国老年学,2017,36(16):2337-2339.DOI:10.3969/j.issn.1005-9202.2016.21.033.
[26]陈茂君,李莉,崔文耀,等.两种血压管理方法在青年高血压脑出血患者中的应用效果[J].西南国防医药,2016,26(3):236-238.DOI:10.3969/j.issn.1004-0188.2016.03.002.
[27]江思德,邹耀兵,唐明山,等.高血压脑出血早期控制血压对血肿扩大的影响[J].重庆医学,2015,44(23):3216-3217.DOI:10.3969/j.issn.1671-8348.2015.23.015.
[28]李芳会.不同收缩压、不同降压方案对老年高血压脑出血患者预后影响的比较研究[J].实用心脑肺血管病杂志,2016,24(3):56-59.DOI:10.3969/j.issn.1008-5971.2016.03.015.
[29]STEPHENSON E,NATHOO N,MAHJOUB Y,et al.Iron in multiple sclerosis:roles in neurodegeneration and repair[J].Nature Reviews Neurology,2014,10(8):459-468.DOI:10.1038/nrneurol.2014.118.
[2]KEEP RF,XI G.Deferoxamine reduces neuronal death and hematoma lysis after intracerebral hemorrhage in aged rats[J].Translational Stroke Research,2013,4(5):546-553.DOI:10.1007/s12975-013-0270-5.
[3]黄明.早期强化降压对高血压脑出血患者颅内血肿及周围水肿的影响[J].中国实用神经疾病杂志,2017,20(19):55-57.DOI:10.3969/j.issn.1673-5110.2017.19.013.
[4]刘文鹏,郑冬,黄家明,等.自发性脑出血患者767例流行病学分析[J].中国综合临床,2015,31(1):33-35.DOI:10.3760/cma.j.issn.1008-6315.2015.01.011.
[5]刘文鹏,郑冬,黄家明,等.2003至2012年间767例自发性脑出血患者的流行病学分析[J/CD].中华神经创伤外科:电子版,2015,1(1):16-19.DOI:10.3877/cma.j.issn.2095-9141.2015.01.005.
[6]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.DOI:10.3760/cma.j.issn.1006-7876.2015.06.002.
[7]QURESHI AI,PALESCH YY,MARTIN R,et al.Effect of systolic blood pressure reduction on hematoma expansion,perihematomal edema,and 3-month outcome among patients with intracerebral hemorrhage:results from the antihypertensive treatment of acute cerebral hemorrhage study[J].Arch Neurol,2010,67(5):570-576.
[8]袁璞,聂文臣.高血压脑出血血肿周围水肿的危险因素分析[J].临床神经外科杂志,2016,13(4):307-309.DOI:10.3969/j.issn.1672-7770.2016.04.018.
[9]魏秀芳,房昕辉,任莉娜,等.自主神经功能对血压变异性的影响[J].国际老年医学杂志,2017,38(3):97-100.DOI:10.3969/j.issn.1674-7593.2017.03.001.
[10]SHI BZ,MENG XF,YANG JX,et al.Effect of erythrocytes on brain water content and haem oxygenase-1 expression in rats with traumatic intracerebral haemorrhage[J].Acta Neurochir(Wien),2012,154(6):1081-1086.DOI:10.1007/s00701-012-1335-z.
[11]刘启云,刘莹莹,韩军丽,等.诊间血压变异性对老年高血压患者血管内皮功能的影响[J].南方医科大学学报,2015,35(9):1320-1324.DOI:10.3969/j.issn.1673-4254.2015.09.021.
[12]DONG M,XI G,KEEP RF,et al.Role of iron in brain lipocalin 2 upregulation after intracerebral hemorrhage in rats[J].Brain Research,2013,1505(6):86-92.DOI:10.1016/j.brainres.2013.02.008.
[13]彭晓晖.脑出血后并发迟发性脑水肿的危险因素分析[J].实用医院临床杂志,2017,14(5):59-61.DOI:10.3969/j.issn.1672-6170.2017.05.019.
[14]丁兴,林海峰.脑出血后脑水肿发病机制研究进展[J].世界最新医学信息文摘,2015,15(86):59-60.DOI:10.3969/j.issn.1671-3141.2015.86.023.
[15]佟冬雪.高血压血肿周围水肿的危险因素分析[J].河北医药,2015,37(18):2841-2844.DOI:10.3969/j.issn.1002-7386.2015.18.043.
[16]杜鹏,哈斯也提·依不来音,木依提·阿不里米提,等.高血压脑出血后血肿增大相关因素分析[J].中华实用诊断与治疗杂志,2016,30(9):875-877.DOI:10.13507/j.issn.1674-3474.2016.09.015.
[17]XIE Q,GU Y,HUA Y,et al.Deferoxamine attenuates white matter injury in a piglet intracerebral hemorrhage model[J].Stroke,2013,45(1):290.DOI:10.1161/STROKEAHA.113.003033.
[18]ROUAULT TA.Iron metabolism in the CNS:implications for neurodegenerative diseases[J].Nature Reviews Neuroscience,2013,14(8):551-564.DOI:10.1038/nrn3453.
[19]付伟,毕东祥,杜文彬,等.铁蛋白在高血压脑出血后血肿周围脑水肿中的作用及机制[J].中国医药导报,2016,13(2):46-49.
[20]LI JY,YUAN LX,ZHANG GM,et al.Activating blood circulation to remove stasis treatment of hypertensive intracerebral hemorrhage:a multi-center prospective randomized open-label blinded-endpoint trial[J].Chinese Journal of Integrative Medicine,2016,22(5):328-334.DOI:10.1007/s11655-016-2467-7.
[21]陈东辉,程宏伟.高血压脑出血术后再出血的多因素分析[J].安徽医科大学学报,2015,50(6):873-876.DOI:10.3969/j.issn.1674-0742.2010.07.078.
[22]王超,游潮,刘窗溪,等.高血压脑出血后血浆及脑脊液IL-1β和IL-6在病情评估中的应用价值[J].中华神经外科杂志,2015,31(11):1158-1160.DOI:10.3760/cma.j.issn.1001-2346.2015.11.019.
[23]YANG G,SHAO GF.Elevated serum IL-11,TNFα,and VEGF expressions contribute to the pathophysiology of hypertensive intracerebral hemorrhage(HICH)[J].Neurological Sciences,2016,37(8):1-7.DOI:10.1007/s10072-016-2576-z.
[24]郝亮,习望,王海燕,等.亚低温治疗对重症高血压脑出血患者血清IL-6及CRP的影响[J].医学临床研究,2015,32(10):1946-1948.DOI:10.3969/j.issn.1671-7171.2015.10.024.
[25]王建国.血清白蛋白与高血压性脑出血血肿周围水肿的相关性分析[J].中国老年学,2017,36(16):2337-2339.DOI:10.3969/j.issn.1005-9202.2016.21.033.
[26]陈茂君,李莉,崔文耀,等.两种血压管理方法在青年高血压脑出血患者中的应用效果[J].西南国防医药,2016,26(3):236-238.DOI:10.3969/j.issn.1004-0188.2016.03.002.
[27]江思德,邹耀兵,唐明山,等.高血压脑出血早期控制血压对血肿扩大的影响[J].重庆医学,2015,44(23):3216-3217.DOI:10.3969/j.issn.1671-8348.2015.23.015.
[28]李芳会.不同收缩压、不同降压方案对老年高血压脑出血患者预后影响的比较研究[J].实用心脑肺血管病杂志,2016,24(3):56-59.DOI:10.3969/j.issn.1008-5971.2016.03.015.
[29]STEPHENSON E,NATHOO N,MAHJOUB Y,et al.Iron in multiple sclerosis:roles in neurodegeneration and repair[J].Nature Reviews Neurology,2014,10(8):459-468.DOI:10.1038/nrneurol.2014.118.