自发性脑出血患者院内死亡或30天内死亡的危险因素分析
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摘要
目的探讨自发性脑出血(sICH)患者院内死亡或30 d内死亡的危险因素及死亡原因。方法回顾性分析2017年9月1日至2018年7月31日武汉大学人民医院急诊科首诊的201例自发性脑出血患者的临床资料,根据患者的预后结局将sICH患者分为死亡组和生存组,通过单因素和多因素分析探讨影响sICH患者预后的危险因素。结果 201例sICH患者中死亡59例,存活142例。死亡组脑出血家族史比例、吸烟比例、收缩压、白细胞计数、随机血糖、血肌酐、D-二聚体、血肿体积、破入脑室比例、中线移位≥5 mm的比例均高于生存组,而死亡组入院格拉斯哥昏迷评分法(GCS)评分显著低于生存组(P <0. 05);多因素Logistic回归分析结果显示,脑出血家族史、入院时GCS评分、血肿体积是影响sICH患者院内死亡或30 d内死亡的危险因素(P <0. 05)。此外,脑疝、感染和急性冠状动脉综合征是sICH患者最常见的死亡原因。结论在sICH患者的诊治过程中,应追踪其脑出血家族史,重视入院时GCS评分、血肿体积,并采取积极措施预防脑疝、感染及急性冠状动脉综合征等并发症的发生、发展,从而更好地改善sICH患者的短期预后。
Objective To explore the risk factors and causes of in-hospital or 30-day mortality of patients with spontaneous intracerebral hemorrhage( sICH). Methods Clinical data of 201 sICH patients admitted to Renmin Hospital of Wuhan University from Sep. 1 st,2017 to Jul. 31 st,2018 was retrospectively analyzed. The cases were divided into a death group and a survival group. The prognostic factors of patients with sICH were analyzed by single-factor and multivariate analysis.Results There were 59 patients death and 142 patients survival among the 201 patients with sICH. The proportions of smoking,family history of cerebral hemorrhage,systolic blood pressure,peripheral leukocyte counts,serum glucose level,serum creatinine,serum D-Dimer,hematoma volume,ruptured ventricles and the midline shift distance≥5 mm at admission of the death group were higher than those of the survival group,while the Glasgow Coma scale( GCS) of the death group was significantly lower than that of the survival group,all with statistical significance( P < 0. 05). Multivariate Logistic regression analysis showed that the family history of cerebral hemorrhage,GCS scores and hematoma volume were independent risk factors of in-hospital 30-day mortality for sICH patients( P < 0. 05). In addition,cerebral hernia,infection and acute coronary syndromes were the most common causes of death of the sICH patients. Conclusion During the diagnosis and treatment of sICH,we should track the family history of cerebral hemorrhage,pay attention to the GCS scores and hematoma volume firstly,and take positive measures to prevent the development of cerebral hernia,infection and acute coronary syndromes,so as to improve the short-term prognosis of the sICH patients.
Objective To explore the risk factors and causes of in-hospital or 30-day mortality of patients with spontaneous intracerebral hemorrhage( sICH). Methods Clinical data of 201 sICH patients admitted to Renmin Hospital of Wuhan University from Sep. 1 st,2017 to Jul. 31 st,2018 was retrospectively analyzed. The cases were divided into a death group and a survival group. The prognostic factors of patients with sICH were analyzed by single-factor and multivariate analysis.Results There were 59 patients death and 142 patients survival among the 201 patients with sICH. The proportions of smoking,family history of cerebral hemorrhage,systolic blood pressure,peripheral leukocyte counts,serum glucose level,serum creatinine,serum D-Dimer,hematoma volume,ruptured ventricles and the midline shift distance≥5 mm at admission of the death group were higher than those of the survival group,while the Glasgow Coma scale( GCS) of the death group was significantly lower than that of the survival group,all with statistical significance( P < 0. 05). Multivariate Logistic regression analysis showed that the family history of cerebral hemorrhage,GCS scores and hematoma volume were independent risk factors of in-hospital 30-day mortality for sICH patients( P < 0. 05). In addition,cerebral hernia,infection and acute coronary syndromes were the most common causes of death of the sICH patients. Conclusion During the diagnosis and treatment of sICH,we should track the family history of cerebral hemorrhage,pay attention to the GCS scores and hematoma volume firstly,and take positive measures to prevent the development of cerebral hernia,infection and acute coronary syndromes,so as to improve the short-term prognosis of the sICH patients.
引文
[1]Van Asch CJ,Luitse MJ,Rinkel GJ,et al. Incidence,case fatality,and functional outcome of intracerebral haemorrhage over time,according to age,sex,and ethnic origin:A systematic review and meta-analysis[J]. Lancet Neurol,2010,9(2):167-176.
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[3]Kothari RU,Brott T,Broderick JP,et al. The ABCs of measuring intracerebral hemorrhage volumes[J]. Stroke,1996,27(8):1304-1305.
[4]Gorelick PB,Furie KL,Iadecola C,et al. Defining Optimal Brain Health in Adults:A Presidential Advisory From the American Heart Association/American Stroke Association[J]. Stroke,2017,48(10):e284-303.
[5]Zhou YT,Tong DM,Wang SD,et al. Acute spontaneous intracerebral hemorrhage and traumatic brain injury are the most common causes of critical illness in the ICU and have high early mortality[J].BMC Neurol,2018,18(1):127-134.
[6]Chen CH,Tang SC,Cheng YW,et al. Detrimental effects of intracerebral haemorrhage on patients with CADASIL harbouring NOTCH3 R544C mutation[J]. J Neurol Neurosurg Psychiatry,2018,17(10):834-836.
[7]S?ndergaard CB,Nielsen JE,Hansen CK,et al. Hereditary cerebral small vessel disease and stroke[J]. Clin Neurol Neurosurg,2017,155(1):45-57.
[8]Sawyer RP,Sekar P,Osborne J,et al. Racial/ethnic variation of APOE alleles for lobar intracerebral hemorrhage[J]. Neurology,2018,91(5):e410-420.
[9]Almufti F,Alkanaq A,Amuluru K,et al. Genetic Insights into Cerebrovascular Disorders:A Comprehensive Review[J]. J Vasc Interv Neurol,2017,9(5):21-32.
[10]Volbers B,Willfarth W,Kuramatsu JB,et al. Impact of Perihemorrhagic Edema on Short-Term Outcome After Intracerebral Hemorrhage[J]. Neurocriti Care,2016,24(3):404-412.
[11]Feng H,Jin Z,He W,et al. Cerebral venous outflow participates in perihematomal edema after spontaneous intracerebral hemorrhage:A cross-sectional study[J]. Medicine,2018,97(35):e12034.
[12]Stokum JA,Gerzanich V,Simard JM. Molecular pathophysiology of cerebral edema[J]. J Cereb Blood Flow Metab,2015,36(3):513-538.
[13]Zis P,Leivadeas P,Michas D,et al. Predicting 30-day case fatality of primary inoperable intracerebral hemorrhage based on findings at the emergency department[J]. J Stroke Cerebrovasc Dis,2014,23(7):1928-1933.
[14]Al-Shahi Salman R,Frantzias J,Lee RJ,et al. Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage:A systematic review and meta-analysis of individual patient data[J]. Lancet Neurol,2018,17(10):885-894.
[15]Chen S,Zhao B,Wang W,et al. Predictors of hematoma expansion predictors after intracerebral hemorrhage[J]. Oncotarget,2017,8(51):89348-89363.
[16]Fan JS,Huang HH,Chen YC,et al. Emergency department neurologic deterioration in patients with spontaneous intracerebral hemorrhage:Incidence,predictors,and prognostic significance[J].Acad Emerg Med,2012,19(2):133-138.
[17]Otite FO,Khandelwal P,Malik AM,et al. Ten-Year Temporal Trends in Medical Complications After Acute Intracerebral Hemorrhage in the United States[J]. Stroke,2017,48(3):596-603.
[18]Venkatasubramanian C,Mlynash M,Finleycaulfield A,et al. Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging[J]. Stroke,2011,42(1):73-80.
[19]Ruthirago D,Julayanont P,Tantrachoti P,et al. Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke[J].Am J Med Sci,2016,351(1):112-118.
[20]Lee DH. Cardiac Complications in Patients Admitted to the NeuroIntensive Care Unit[J]. J Neurocrit Care,2017,10(1):7-12.
[21]Tahsili-Fahadan P,Geocadin RG. Heart-Brain Axis:Effects of Neurologic Injury on Cardiovascular Function[J]. Circ Res,2017,120(3):559-572.
[22]Chen Z,Venkat P,Seyfried D,et al. Brain-Heart Interaction:Cardiac Complications After Stroke[J]. Circ Res,2017,121(4):451-468.
[23]Rutten-Jacobs LC,Maaijwee NA,Arntz RM,et al. Clinical characteristics and outcome of intracerebral hemorrhage in young adults[J].J Neurol,2014,261(11):2143-2149.
[24]Putaala J,Lehto M,Meretoja A,et al. In-hospital cardiac complications after intracerebral hemorrhage[J]. Int J Stroke,2014,9(6):741-746.
[25]Lee M,Oh JH,Lee KB,et al. Clinical and Echocardiographic Characteristics of Acute Cardiac Dysfunction Associated With Acute Brain Hemorrhage-Difference From Takotsubo Cardiomyopathy[J]. Circ J,2016,80(9):2026-2032.
[26]Shi K,Wood K,Shi F,et al. Stroke-induced immunosuppression and poststroke infection[J]. Stroke Vasc Neurol,2018,3(1):34-41.
[2]Hemphill JR,Greenberg SM,Anderson CS,et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage:A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke,2015,46(7):2032-2060.
[3]Kothari RU,Brott T,Broderick JP,et al. The ABCs of measuring intracerebral hemorrhage volumes[J]. Stroke,1996,27(8):1304-1305.
[4]Gorelick PB,Furie KL,Iadecola C,et al. Defining Optimal Brain Health in Adults:A Presidential Advisory From the American Heart Association/American Stroke Association[J]. Stroke,2017,48(10):e284-303.
[5]Zhou YT,Tong DM,Wang SD,et al. Acute spontaneous intracerebral hemorrhage and traumatic brain injury are the most common causes of critical illness in the ICU and have high early mortality[J].BMC Neurol,2018,18(1):127-134.
[6]Chen CH,Tang SC,Cheng YW,et al. Detrimental effects of intracerebral haemorrhage on patients with CADASIL harbouring NOTCH3 R544C mutation[J]. J Neurol Neurosurg Psychiatry,2018,17(10):834-836.
[7]S?ndergaard CB,Nielsen JE,Hansen CK,et al. Hereditary cerebral small vessel disease and stroke[J]. Clin Neurol Neurosurg,2017,155(1):45-57.
[8]Sawyer RP,Sekar P,Osborne J,et al. Racial/ethnic variation of APOE alleles for lobar intracerebral hemorrhage[J]. Neurology,2018,91(5):e410-420.
[9]Almufti F,Alkanaq A,Amuluru K,et al. Genetic Insights into Cerebrovascular Disorders:A Comprehensive Review[J]. J Vasc Interv Neurol,2017,9(5):21-32.
[10]Volbers B,Willfarth W,Kuramatsu JB,et al. Impact of Perihemorrhagic Edema on Short-Term Outcome After Intracerebral Hemorrhage[J]. Neurocriti Care,2016,24(3):404-412.
[11]Feng H,Jin Z,He W,et al. Cerebral venous outflow participates in perihematomal edema after spontaneous intracerebral hemorrhage:A cross-sectional study[J]. Medicine,2018,97(35):e12034.
[12]Stokum JA,Gerzanich V,Simard JM. Molecular pathophysiology of cerebral edema[J]. J Cereb Blood Flow Metab,2015,36(3):513-538.
[13]Zis P,Leivadeas P,Michas D,et al. Predicting 30-day case fatality of primary inoperable intracerebral hemorrhage based on findings at the emergency department[J]. J Stroke Cerebrovasc Dis,2014,23(7):1928-1933.
[14]Al-Shahi Salman R,Frantzias J,Lee RJ,et al. Absolute risk and predictors of the growth of acute spontaneous intracerebral haemorrhage:A systematic review and meta-analysis of individual patient data[J]. Lancet Neurol,2018,17(10):885-894.
[15]Chen S,Zhao B,Wang W,et al. Predictors of hematoma expansion predictors after intracerebral hemorrhage[J]. Oncotarget,2017,8(51):89348-89363.
[16]Fan JS,Huang HH,Chen YC,et al. Emergency department neurologic deterioration in patients with spontaneous intracerebral hemorrhage:Incidence,predictors,and prognostic significance[J].Acad Emerg Med,2012,19(2):133-138.
[17]Otite FO,Khandelwal P,Malik AM,et al. Ten-Year Temporal Trends in Medical Complications After Acute Intracerebral Hemorrhage in the United States[J]. Stroke,2017,48(3):596-603.
[18]Venkatasubramanian C,Mlynash M,Finleycaulfield A,et al. Natural history of perihematomal edema after intracerebral hemorrhage measured by serial magnetic resonance imaging[J]. Stroke,2011,42(1):73-80.
[19]Ruthirago D,Julayanont P,Tantrachoti P,et al. Cardiac Arrhythmias and Abnormal Electrocardiograms After Acute Stroke[J].Am J Med Sci,2016,351(1):112-118.
[20]Lee DH. Cardiac Complications in Patients Admitted to the NeuroIntensive Care Unit[J]. J Neurocrit Care,2017,10(1):7-12.
[21]Tahsili-Fahadan P,Geocadin RG. Heart-Brain Axis:Effects of Neurologic Injury on Cardiovascular Function[J]. Circ Res,2017,120(3):559-572.
[22]Chen Z,Venkat P,Seyfried D,et al. Brain-Heart Interaction:Cardiac Complications After Stroke[J]. Circ Res,2017,121(4):451-468.
[23]Rutten-Jacobs LC,Maaijwee NA,Arntz RM,et al. Clinical characteristics and outcome of intracerebral hemorrhage in young adults[J].J Neurol,2014,261(11):2143-2149.
[24]Putaala J,Lehto M,Meretoja A,et al. In-hospital cardiac complications after intracerebral hemorrhage[J]. Int J Stroke,2014,9(6):741-746.
[25]Lee M,Oh JH,Lee KB,et al. Clinical and Echocardiographic Characteristics of Acute Cardiac Dysfunction Associated With Acute Brain Hemorrhage-Difference From Takotsubo Cardiomyopathy[J]. Circ J,2016,80(9):2026-2032.
[26]Shi K,Wood K,Shi F,et al. Stroke-induced immunosuppression and poststroke infection[J]. Stroke Vasc Neurol,2018,3(1):34-41.