CAJ | 학술논문

目的：探讨脑出血并发应激性溃疡（SU）的相关危险因素。方法回顾性分析2006年3月至2014年3月南京军区南京总医院急救医学科抢救室收治1185例脑出血患者的临床资料，以是否合并SU将患者分为两组。采集两组患者入院8h内的数据，包括性别、年龄、出血量、出血部位（基底节区、丘脑、脑干、脑叶、脑室、蛛网膜下腔、小脑）、意识障碍、急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分、收缩压（SBP）、高血压病史、脑出血病史9项指标进行单因素分析，将有统计学意义的危险因素进行多因素logistic回归分析，筛选独立危险因素，并绘制受试者工作特征曲线（ROC曲线），评价其检验效能。结果1185例脑出血患者入选本研究，293例发生SU，占24.7%；892例未发生SU，占75.3%。单因素分析显示，脑出血并发SU的危险因素包括年龄、出血量、出血部位、意识障碍、APACHEⅡ评分、SBP。在出血部位中，脑室、丘脑、脑干出血并发SU的比例较高，分别为45.3%（43/95）、39.1%（63/161）、36.9%（48/130），显著高于脑叶〔26.2%（33/126）〕、小脑〔18.8%（15/80）〕、基底节区〔16.1%（78/485）〕、蛛网膜下腔〔12.0%（13/108）〕。多因素logistic回归分析显示，出血量〔优势比（OR）＝3.305，P＝0.001，95%可信区间（95%CI）为2.213～48.634〕、出血部位（OR＝1.762，P＝0.008，95%CI为0.123～2.743）、SBP（OR＝1.223，P＝0.034，95%CI为0.245～2.812）是脑出血并发SU的独立危险因素。出血量、SBP的ROC曲线下面积（AUC）分别为0.846、0.597，提示出血量有中等的诊断价值，SBP的诊断价值较低。结论出血量大，出血部位在脑室、丘脑或脑干，SBP高的脑出血患者并发SU的风险较大，应尽早降低血压并及时给予SU的预防性治疗。
목적：탐토뇌출혈병발응격성궤양（SU）적상관위험인소。방법회고성분석2006년3월지2014년3월남경군구남경총의원급구의학과창구실수치1185례뇌출혈환자적림상자료，이시부합병SU장환자분위량조。채집량조환자입원8h내적수거，포괄성별、년령、출혈량、출혈부위（기저절구、구뇌、뇌간、뇌협、뇌실、주망막하강、소뇌）、의식장애、급성생이학여만성건강상황평분계통Ⅱ（APACHEⅡ）평분、수축압（SBP）、고혈압병사、뇌출혈병사9항지표진행단인소분석，장유통계학의의적위험인소진행다인소logistic회귀분석，사선독립위험인소，병회제수시자공작특정곡선（ROC곡선），평개기검험효능。결과1185례뇌출혈환자입선본연구，293례발생SU，점24.7%；892례미발생SU，점75.3%。단인소분석현시，뇌출혈병발SU적위험인소포괄년령、출혈량、출혈부위、의식장애、APACHEⅡ평분、SBP。재출혈부위중，뇌실、구뇌、뇌간출혈병발SU적비례교고，분별위45.3%（43/95）、39.1%（63/161）、36.9%（48/130），현저고우뇌협〔26.2%（33/126）〕、소뇌〔18.8%（15/80）〕、기저절구〔16.1%（78/485）〕、주망막하강〔12.0%（13/108）〕。다인소logistic회귀분석현시，출혈량〔우세비（OR）＝3.305，P＝0.001，95%가신구간（95%CI）위2.213～48.634〕、출혈부위（OR＝1.762，P＝0.008，95%CI위0.123～2.743）、SBP（OR＝1.223，P＝0.034，95%CI위0.245～2.812）시뇌출혈병발SU적독립위험인소。출혈량、SBP적ROC곡선하면적（AUC）분별위0.846、0.597，제시출혈량유중등적진단개치，SBP적진단개치교저。결론출혈량대，출혈부위재뇌실、구뇌혹뇌간，SBP고적뇌출혈환자병발SU적풍험교대，응진조강저혈압병급시급여SU적예방성치료。
Objective To explore the related risk factors of cerebral hemorrhage complicated with stress ulcer (SU). Methods The clinical data of 1 185 patients with cerebral hemorrhage admitted to Department of Emergency Medicine of Nanjing General Hospital from March 2006 to March 2014 were retrospectively analyzed. Patients were divided into two groups according to whether patients complicated with SU or not. Data was collected within 8 hours after admission in two groups including gender,age,amount of bleeding,the bleeding site (basal ganglia,thalamus, brainstem,brain lobe,ventricle,subarachnoid,and cerebellum),disturbance of consciousness,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score,systolic blood pressure(SBP),history of hypertension,and history of cerebral hemorrhage. The statistically significant risk factors found using univariate analysis was selected and was analyzed to find independent risk factors with multivariate logistic regression analysis. The receiver operating characteristic curve (ROC curve)was plotted to analyze the independent risk factors and evaluate their power of test. Results 1 185 patients with cerebral hemorrhage were enrolled in the study,293 cases occurred SU,accounting for 24.7%,and 892 cases without SU,which accounted for 75.3%. As shown by univariate analysis,risk factors for cerebral hemorrhage complicated with SU included age,amount of bleeding,the bleeding site,disturbance of consciousness,APACHEⅡscore,SBP. As to the site of bleeding,brain,thalamus,brainstem hemorrhage complicated with SU were higher proportion,45.3%(43/95),39.1%(63/161),36.9%(48/130),which were significantly higher than those of the lobes of the brain 〔26.2% (33/126)〕,cerebellum 〔18.8% (15/80)〕,basal ganglia〔16.1%(78/485)〕,arachnoid the inferior vena cava 〔12.0% (13/108)〕. Multivariate logistic regression analysis showed that amount of bleeding 〔odds ratio (OR)=3.305,P=0.001,95%confidence interval (95%CI)2.213-48.634〕,the bleeding site (OR=1.762,P=0.008,95%CI 0.123-2.743),SBP (OR=1.223,P=0.034,95%CI 0.245-2.812) were independent risk factors of cerebral hemorrhage complicated with SU. The area under the ROC curve (AUC)of amount of bleeding and SBP were 0.846 and 0.597,suggesting that amount of bleeding has moderate diagnostic value and SBP has low diagnostic value. Conclusions Cerebral hemorrhage patients with large amount of bleeding,the bleeding site in the ventricle,thalamus or brainstem,high SBP are of great risk. We should lower blood pressure and give preventive treatment for SU as soon as possible.