浙江中西医结合杂志
浙江中西醫結閤雜誌
절강중서의결합잡지
ZHEJIANG JOURNAL OF INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE
2015年
8期
716-719
,共4页
王建龙%曹利民%李红琴%裴静波
王建龍%曹利民%李紅琴%裴靜波
왕건룡%조이민%리홍금%배정파
急性脑出血%腑气通畅%危险因素%近期预后
急性腦齣血%腑氣通暢%危險因素%近期預後
급성뇌출혈%부기통창%위험인소%근기예후
cerebral hemorrhage%bowel gas patency%risk factors%short-term prognosis
目的：探讨急性脑出血患者近期临床转归与腑气通畅程度的关系。方法前瞻性连续纳入发病24h内入院的自发性幕上脑出血患者。制定统一的资料收集表，收集人口统计学资料（年龄、性别）、血管危险因素（高血压、糖尿病、高脂血症、吸烟、饮酒）、入院时临床神经功能缺损评分按照美国国立卫生院卒中量表（NIHSS）、放射学资料（血肿部位、血肿体积）、实验室检查结果（白细胞计数、血糖、血脂、C-反应蛋白）、发病后第一次排便时间、2周内排便次数。发病后1个月应用改良Rankin量表（mRS）评价临床转归，以mRS评分≤2分定义为转归良好组，mRS评分≥3分定义为转归不良组。结果共纳入113例急性脑出血患者，其中转归不良组68例（60.2％），转归良好组45例（39.8％）。单变量分析显示，转归不良组与转归良好组比较，血肿体积[（26.67±7.94）cm3对（22.86±7.42）cm3；t＝2.542，P＝0.012]、NIHSS 评分[（20.18±6.95）分比（16.02±6.62）分；t＝3.17，P＝0.002]、白细胞数[（10.28±3.06）×109/L比（8.91±2.88）×109/L；t＝2.379，P＝0.019]、空腹血糖[（8.45±1.73） mmol/L比（7.08±1.67）mmol/L；t＝4.166，P＝0.000）]、甘油三酯[（2.26±0.97）mmol/L比（1.74±0.85）mmol/L；t＝2.929，P＝0.004]、C反应蛋白[（11.01±6.08）mg/L比（8.89±3.75）mg/L；t＝2.096，P＝0.038]、第一次排便时间[（33.87±15.14）h比（24.33±8.69）h；t＝3.825，P＝0.000]、2周内排便次数[（7.57±3.41）次比（10.62±2.44）次；t＝-5.175，P＝0.000]。多变量logistic回归分析显示，血肿体积较大[优势比（OR）1.092，95％可信区间（CI）1.002~1.189；P＝0.044]、第一次排便时间较长（OR 1.114，95％CI 1.008~1.221；P＝0.000）是急性脑出血患者短期临床转归的独立预测因素。结论脑出血后第一次排便时间的间隔长短是脑出血患者短期临床转归的独立预测因素之一。
目的：探討急性腦齣血患者近期臨床轉歸與腑氣通暢程度的關繫。方法前瞻性連續納入髮病24h內入院的自髮性幕上腦齣血患者。製定統一的資料收集錶，收集人口統計學資料（年齡、性彆）、血管危險因素（高血壓、糖尿病、高脂血癥、吸煙、飲酒）、入院時臨床神經功能缺損評分按照美國國立衛生院卒中量錶（NIHSS）、放射學資料（血腫部位、血腫體積）、實驗室檢查結果（白細胞計數、血糖、血脂、C-反應蛋白）、髮病後第一次排便時間、2週內排便次數。髮病後1箇月應用改良Rankin量錶（mRS）評價臨床轉歸，以mRS評分≤2分定義為轉歸良好組，mRS評分≥3分定義為轉歸不良組。結果共納入113例急性腦齣血患者，其中轉歸不良組68例（60.2％），轉歸良好組45例（39.8％）。單變量分析顯示，轉歸不良組與轉歸良好組比較，血腫體積[（26.67±7.94）cm3對（22.86±7.42）cm3；t＝2.542，P＝0.012]、NIHSS 評分[（20.18±6.95）分比（16.02±6.62）分；t＝3.17，P＝0.002]、白細胞數[（10.28±3.06）×109/L比（8.91±2.88）×109/L；t＝2.379，P＝0.019]、空腹血糖[（8.45±1.73） mmol/L比（7.08±1.67）mmol/L；t＝4.166，P＝0.000）]、甘油三酯[（2.26±0.97）mmol/L比（1.74±0.85）mmol/L；t＝2.929，P＝0.004]、C反應蛋白[（11.01±6.08）mg/L比（8.89±3.75）mg/L；t＝2.096，P＝0.038]、第一次排便時間[（33.87±15.14）h比（24.33±8.69）h；t＝3.825，P＝0.000]、2週內排便次數[（7.57±3.41）次比（10.62±2.44）次；t＝-5.175，P＝0.000]。多變量logistic迴歸分析顯示，血腫體積較大[優勢比（OR）1.092，95％可信區間（CI）1.002~1.189；P＝0.044]、第一次排便時間較長（OR 1.114，95％CI 1.008~1.221；P＝0.000）是急性腦齣血患者短期臨床轉歸的獨立預測因素。結論腦齣血後第一次排便時間的間隔長短是腦齣血患者短期臨床轉歸的獨立預測因素之一。
목적：탐토급성뇌출혈환자근기림상전귀여부기통창정도적관계。방법전첨성련속납입발병24h내입원적자발성막상뇌출혈환자。제정통일적자료수집표，수집인구통계학자료（년령、성별）、혈관위험인소（고혈압、당뇨병、고지혈증、흡연、음주）、입원시림상신경공능결손평분안조미국국립위생원졸중량표（NIHSS）、방사학자료（혈종부위、혈종체적）、실험실검사결과（백세포계수、혈당、혈지、C-반응단백）、발병후제일차배편시간、2주내배편차수。발병후1개월응용개량Rankin량표（mRS）평개림상전귀，이mRS평분≤2분정의위전귀량호조，mRS평분≥3분정의위전귀불량조。결과공납입113례급성뇌출혈환자，기중전귀불량조68례（60.2％），전귀량호조45례（39.8％）。단변량분석현시，전귀불량조여전귀량호조비교，혈종체적[（26.67±7.94）cm3대（22.86±7.42）cm3；t＝2.542，P＝0.012]、NIHSS 평분[（20.18±6.95）분비（16.02±6.62）분；t＝3.17，P＝0.002]、백세포수[（10.28±3.06）×109/L비（8.91±2.88）×109/L；t＝2.379，P＝0.019]、공복혈당[（8.45±1.73） mmol/L비（7.08±1.67）mmol/L；t＝4.166，P＝0.000）]、감유삼지[（2.26±0.97）mmol/L비（1.74±0.85）mmol/L；t＝2.929，P＝0.004]、C반응단백[（11.01±6.08）mg/L비（8.89±3.75）mg/L；t＝2.096，P＝0.038]、제일차배편시간[（33.87±15.14）h비（24.33±8.69）h；t＝3.825，P＝0.000]、2주내배편차수[（7.57±3.41）차비（10.62±2.44）차；t＝-5.175，P＝0.000]。다변량logistic회귀분석현시，혈종체적교대[우세비（OR）1.092，95％가신구간（CI）1.002~1.189；P＝0.044]、제일차배편시간교장（OR 1.114，95％CI 1.008~1.221；P＝0.000）시급성뇌출혈환자단기림상전귀적독립예측인소。결론뇌출혈후제일차배편시간적간격장단시뇌출혈환자단기림상전귀적독립예측인소지일。
Objective To investigate the relationship between the bowel gas patency and recent clinical out-comes in patients with acute cerebral hemorrhage. Methods Consecutive patients with spontaneous intracerebral hemorrhage admitted within 24h after onset were prospectively included. A unified data collection form was formu-lated to collect demographic information data (age, gender), vascular risk factors (hypertension, diabetes, hyperlipi-demia, smoking, drinking), admission clinical neurological deficit score according to the U.S. National Institutes of Health Stroke Scale(NIHSS), radiology information(hematoma location, hematoma volume), the test results of labo-ratory (white blood cell count, blood glucose, blood lipids, C-reactive protein), the first defecation time after the occurrence of the disease and defecation frequency in 2 weeks. Modified Rankin Scale(mRS) was used to evaluate the clinical outcome in a month. The patients were divided into a good outcome group (mRS≤2) and a poor out-come group (mRS≥3). Results A total of 113 patients with acute cerebral hemorrhage were included, with 68 patients(60.2%) in poor outcome group and 45 patients(39.8%) in good outcome group. Univariate analysis showed that the hematoma volume(26.67±7.94cm3 vs 22.86±7.42cm3; t=2.542, P=0.012), the NIHSS(20.18±6.95 vs 16.02± <br> 6.62; t=3.17, P=0.002), white blood cell count [(10.28±3.06)×109 vs (8.91±2.88)×109; t=2.379, P=0.019], fasting glucose(8.45±1.73mmol/L vs 7.08±1.67mmol/L;t=4.166, P=0.000), triglycerides(2.26±0.97mmol/L vs 1.74±0.85mmol/L; t=2.929, P=0.004), C-reactive protein(11.01±6.08mg/L vs 8.89±3.75mg/L; t=2.096, P=0.038) and first defecation time(33.87±15.14h vs 24.33±8.69h; t=3.825, P=0.000) in poor outcome group was significantly higher than those in good outcome group. The number of bowel movements of poor outcome group within 2 weeks was significantly low-er than of good outcome group(7.57±3.41 times vs 10.62±2.44 times; t=-5.175, P=0.000). Multivariable logistic re-gression analysis showed that larger hematoma volume(odds ratio [OR]=1.092, 95% confidence interval [CI]: 1.002-1.189; P=0.044) and longer first defecation time (OR=1.114, 95%CI 1.008-1.221;P=0.000) were the independent predictor factors for the short-term clinical outcomes in patients with acute cerebral hemorrhage. Conclusion The length of the time interval from cerebral hemorrhage to the first defecation was one of the independent predictors for short-term clinical outcomes in patients with cerebral hemorrhage.
