高血压性脑出血早期血肿扩大的临床分析-clinical analysis of early hematoma enlargement in hypertensive intracerebral hemorrhage.docxVIP

— — PAGE 1— 摘 要 高血压性脑出血早期血肿扩大的临床研究 硕士研究生：王修军 导师：张小宁 教授 摘 要 目的：初步探讨高血压性脑出血(HICH)早期血肿扩大的临床特点及相关因素。 方法：回顾性分析 2007 年 1 月至 2009 年 5 月在新疆医科大学第一附属医院住院的 285 例 HICH 患者的临床资料，根据是否存在早期血肿扩大分为两组，对两组资料进 行对比性分析。结果：共纳入发病 24 小时内的 HICH 患者 285 例，77 例发生血肿扩 大(27.02%)；发病 6 小时内的患者较 6-24h 的血肿扩大发生率高，相比差异有显著统 计学意义(P=0.000)；血肿扩大组患者发病首测收缩压、舒张压、脉压平均值均高于 血肿稳定组，两组比较差异有统计学意义(P=0.005)；多因素分析显示血肿扩大的相 关影响因素有：高血压病程、首测脉压、早期使用甘露醇、24h 甘露醇使用量、大量 饮酒史、入院时昏迷评分、血肿部位、血肿形态；血肿扩大组的手术治疗率、病死 率明显较血肿稳定组高，经比较差异均有统计学意义(P=0.000)。结论：1、本组资料 显示 HICH 早期血肿扩大的发生率为 27.02%；2、HICH 早期血肿扩大多发生于发病 后 6h 以内；3、HICH 早期血肿扩大为多种因素、多种机制共同作用的结果；4、HICH 早期血肿扩大患者预后差、病死率高。 关键词：高血压性脑出血 血肿扩大 相关因素 新疆医科大学医学硕士学位论文 Clinical study of early hematoma growth in hypertensive intracerebral hemorrhage Postgraduate : Wang Xiujun Supervisor Zhang Xiaoning Abstract Objective: To explore the clinical characteristics and correlative factors of early hematoma growth in hypertensive intracerebral hemorrhage(HICH). Methods: To review the clinical data of the 285 patients with HICH in the First Affiliated Hospital Xinjiang Medical University from January 2007 to May 2009. Divide all the patients into two groups according to having early hematoma growth or not. And the data of the two groups were compared. Results: 285 patients within 24 hours after onset were included. 77 patients (27.02%) were demonstrated hematoma growth. The rate of hematoma growth of patients with HICH was higher in 6 hours after onset than that from 6 to 24 hours after onset. There were significant differences between two groups (P=0.000);The mean value of systolic blood pressure, diastolic blood pressure and pulse pressure were all higher in the enlarged group than that in the non-enlarged group. And there were significant differences between two groups (P=0.005);Multivariate analysis demonstrated that the course of hypertension, first pulse pressure, early using mannitol, the dosis of mannitol in 24h, Glasgow Coma Scale(GCS), drinking and the site of hematoma, the shape of hematoma were correlat