CAJ | 학술논문

目的研究急性脑出血（intracerebral hemorrhage，ICH）患者继发性脑水肿的相关因素及对ICH患者预后的影响。 　　方法本研究为前瞻性研究，连续收集发病24 h内的ICH住院患者51例。患者到院时收集临床基线信息、完成实验室检查和常规头颅平扫计算机断层扫描（computed tomography，CT）以评价基线脑水肿情况。发病（12±2）d行常规头颅平扫CT及CT血管成像一站式检查，以完成高峰期水肿情况及脑血管系统评价。分别在就诊、出院和发病后90 d进行神经功能评价。 　　结果在51例入组患者中，基底节区出血36例，丘脑出血7例，脑叶出血8例。本研究发现初始水肿体积（V初始水肿）与初始血肿体积（V初始血肿）正相关（r=0.799，P＜0.001）；初始水肿指数（EI初始）与服用抗血小板药物负相关（r=-2.456，P=0.014）。高峰期水肿体积（V高峰水肿）与V初始水肿（r=0.720，P＜0.001）、V初始血肿（r=0.779，P＜0.001）和高峰期血肿体积（V高峰血肿）（r=0.788，P＜0.001）呈正相关；高峰期水肿指数（EI高峰）与EI初始正相关（r=0.357，P=0.010）。本组患者中V初始水肿与就诊ICH功能预后量表（Functional Outcome after ICH，FUNC）评分（r=-0.355，P=0.011）、格拉斯哥昏迷量表（Glasgow Coma Scale，GCS）评分（r=-0.419，P=0.002）、原始脑出血量表（the Original ICH Scale，oICH）评分（r=0.364， P=0.009）、出院（r=0.520，P＜0.001）及发病后90 d（r=0.481，P＜0.001）改良Rankin量表（modified Rankin Scale，mRS）评分以及出院时美国国立卫生研究院卒中量表（National Institutes of Health Stroke Scale，NIHSS）评分（r=0.526，P＜0.001）相关；V高峰水肿与就诊时NIHSS评分（r=0.455，P=0.001）、FUNC评分（r=-0.327，P=0.019）、GCS评分（r=-0.436，P=0.001）、出院（r=0.564，P＜0.001）及发病后90 d（r=0.590，P＜0.001）mRS评分以及出院时NIHSS评分（r=0.541，P＜0.001）相关。 　　结论 ICH患者存在继发性脑水肿，初始水肿严重程度与初始血肿体积、既往应用抗血小板药物等因素相关，高峰期水肿严重程度与初始水肿、血肿体积，高峰血肿体积以及初始水肿指数等因素相关。ICH患者急性期疾病严重程度和90 d预后与初始和高峰期脑水肿体积相关。目的研究急性腦齣血（intracerebral hemorrhage，ICH）患者繼髮性腦水腫的相關因素及對ICH患者預後的影響。 　　方法本研究為前瞻性研究，連續收集髮病24 h內的ICH住院患者51例。患者到院時收集臨床基線信息、完成實驗室檢查和常規頭顱平掃計算機斷層掃描（computed tomography，CT）以評價基線腦水腫情況。髮病（12±2）d行常規頭顱平掃CT及CT血管成像一站式檢查，以完成高峰期水腫情況及腦血管繫統評價。分彆在就診、齣院和髮病後90 d進行神經功能評價。 　　結果在51例入組患者中，基底節區齣血36例，丘腦齣血7例，腦葉齣血8例。本研究髮現初始水腫體積（V初始水腫）與初始血腫體積（V初始血腫）正相關（r=0.799，P＜0.001）；初始水腫指數（EI初始）與服用抗血小闆藥物負相關（r=-2.456，P=0.014）。高峰期水腫體積（V高峰水腫）與V初始水腫（r=0.720，P＜0.001）、V初始血腫（r=0.779，P＜0.001）和高峰期血腫體積（V高峰血腫）（r=0.788，P＜0.001）呈正相關；高峰期水腫指數（EI高峰）與EI初始正相關（r=0.357，P=0.010）。本組患者中V初始水腫與就診ICH功能預後量錶（Functional Outcome after ICH，FUNC）評分（r=-0.355，P=0.011）、格拉斯哥昏迷量錶（Glasgow Coma Scale，GCS）評分（r=-0.419，P=0.002）、原始腦齣血量錶（the Original ICH Scale，oICH）評分（r=0.364， P=0.009）、齣院（r=0.520，P＜0.001）及髮病後90 d（r=0.481，P＜0.001）改良Rankin量錶（modified Rankin Scale，mRS）評分以及齣院時美國國立衛生研究院卒中量錶（National Institutes of Health Stroke Scale，NIHSS）評分（r=0.526，P＜0.001）相關；V高峰水腫與就診時NIHSS評分（r=0.455，P=0.001）、FUNC評分（r=-0.327，P=0.019）、GCS評分（r=-0.436，P=0.001）、齣院（r=0.564，P＜0.001）及髮病後90 d（r=0.590，P＜0.001）mRS評分以及齣院時NIHSS評分（r=0.541，P＜0.001）相關。 　　結論 ICH患者存在繼髮性腦水腫，初始水腫嚴重程度與初始血腫體積、既往應用抗血小闆藥物等因素相關，高峰期水腫嚴重程度與初始水腫、血腫體積，高峰血腫體積以及初始水腫指數等因素相關。ICH患者急性期疾病嚴重程度和90 d預後與初始和高峰期腦水腫體積相關。
목적연구급성뇌출혈（intracerebral hemorrhage，ICH）환자계발성뇌수종적상관인소급대ICH환자예후적영향。 　　방법본연구위전첨성연구，련속수집발병24 h내적ICH주원환자51례。환자도원시수집림상기선신식、완성실험실검사화상규두로평소계산궤단층소묘（computed tomography，CT）이평개기선뇌수종정황。발병（12±2）d행상규두로평소CT급CT혈관성상일참식검사，이완성고봉기수종정황급뇌혈관계통평개。분별재취진、출원화발병후90 d진행신경공능평개。 　　결과재51례입조환자중，기저절구출혈36례，구뇌출혈7례，뇌협출혈8례。본연구발현초시수종체적（V초시수종）여초시혈종체적（V초시혈종）정상관（r=0.799，P＜0.001）；초시수종지수（EI초시）여복용항혈소판약물부상관（r=-2.456，P=0.014）。고봉기수종체적（V고봉수종）여V초시수종（r=0.720，P＜0.001）、V초시혈종（r=0.779，P＜0.001）화고봉기혈종체적（V고봉혈종）（r=0.788，P＜0.001）정정상관；고봉기수종지수（EI고봉）여EI초시정상관（r=0.357，P=0.010）。본조환자중V초시수종여취진ICH공능예후량표（Functional Outcome after ICH，FUNC）평분（r=-0.355，P=0.011）、격랍사가혼미량표（Glasgow Coma Scale，GCS）평분（r=-0.419，P=0.002）、원시뇌출혈량표（the Original ICH Scale，oICH）평분（r=0.364， P=0.009）、출원（r=0.520，P＜0.001）급발병후90 d（r=0.481，P＜0.001）개량Rankin량표（modified Rankin Scale，mRS）평분이급출원시미국국립위생연구원졸중량표（National Institutes of Health Stroke Scale，NIHSS）평분（r=0.526，P＜0.001）상관；V고봉수종여취진시NIHSS평분（r=0.455，P=0.001）、FUNC평분（r=-0.327，P=0.019）、GCS평분（r=-0.436，P=0.001）、출원（r=0.564，P＜0.001）급발병후90 d（r=0.590，P＜0.001）mRS평분이급출원시NIHSS평분（r=0.541，P＜0.001）상관。 　　결론 ICH환자존재계발성뇌수종，초시수종엄중정도여초시혈종체적、기왕응용항혈소판약물등인소상관，고봉기수종엄중정도여초시수종、혈종체적，고봉혈종체적이급초시수종지수등인소상관。ICH환자급성기질병엄중정도화90 d예후여초시화고봉기뇌수종체적상관。
Objective To evaluate the nature history of perihematomal edema (PHE) in intracerebral hemorrhage (ICH) patients using X-ray computed tomography (CT), to analyze the predictive factors of the severity of initial and peak PHE, and to explore the relationship between PHE and clinical outcome. Methods It was a retrospective study of consecutive patients with ICH admitted to Beijing Tiantan Hospital from October 2009 to November 2011. Medical records, laboratory data, and CT scan were performed at admission. On (12±2) days after ICH, CT angiography and venography were given to analyze peak edema and cerebral vascular system. Neurologic assessments were performed at admission, patient discharge and 3 months after ICH. Results Among 51 patients enrolled, there were 36 cases of basal ganglia hemorrhage, 7 cases of thalamus hemorrhage and 8 cases of lobar hemorrhage. According to our study, baseline hematoma volume was the only correlation factor of baseline edema volume (r=0.799, P<0.001) and antiplatelet use on admission is associated with more severe relative baseline edema (r=-2.456, P=0.014). Peak edema volume had a positive correlation with both baseline edema (r=0.720, P<0.001) and hematoma volume and peak hematoma volume (r=0.788, P<0.001). Peak edema index is only related with baseline edema index (r=0.357, P=0.010). This study revealed signiifcant relationship between the baseline/peak edema volume and acute clinical deterioration/modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) on discharge and 90 days of onset, but failed to ifnd correlations between baseline/peak edema index and clinical outcomes. Conclusion Antiplatelet use on admission is associated with more severe relative baseline edema. Acute clinical deterioration and long-term functional outcome after ICH are only correlated to initial absolute PHE severity.