Long-term Outcomes and Risk Factors Related to Hydrocephalus After Intracerebral Hemorrhage
Long-term Outcomes and Risk Factors Related to Hydrocephalus After Intracerebral Hemorrhage
复制标题
脑出血后脑积水相关的长期结果和危险因素
DOI：
10.1007/s12975-020-00823-y
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发表时间：
2020-06-08
影响因子：
6.9
通讯作者：
Feng, Hua
中科院分区：
文献类型：
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作者：
Hu, Rong;Zhang, Chao;Feng, Hua
脑出血后脑积水是一种常见的可治疗的并发症。然而，预测脑积水的长期结果和因素很少被研究。本研究的目的是确定脑出血后脑积水的长期结局并分析危险因素。我们回顾了2010-2016年间连续的1342例脑出血患者，以确定脑积水的重要危险因素。对首次发生脑出血但在脑出血后未发现脑积水的患者进行生存状况和死亡原因的随访。采用Logistic回归分析对脑积水的危险因素进行评估。在1342例脑出血患者中，120例(8.9%)出现脑积水。脑积水(≤ 3~d)的危险因素为幕下出血(p= 0.000)、脑室侵犯(p= 0.000)、脑出血量大(p= 0.09)和血肿扩大(p= 0.01)。脑室扩张(p= 0.022)是脑积水(4~13天)的唯一独立危险因素，脑室扩张(p= 0.028)、开颅去骨瓣减压术(p= 0.032)和颅内感染(p= 0.001)是脑积水(≥ 14天)的独立预测因素。患者平均随访时间为5.2年(IQR 3.3~7.3年)。有脑积水的脑出血患者的全因死亡率显著高于无脑积水患者(HR3.22，95%CI2.42-4.28；p= 0.000)。脑积水患者中59例(49.2%)死亡，40例(33.3%)预后良好。在所有死亡中，30.5%死于脑出血，64.4%死于感染。脑积水是脑出血的一种常见并发症，最常发生在脑出血发病时。脑积水患者的死亡率相对较高。ClinicalTrials.gov标识：NCT02135783(2014年5月7日)
Hydrocephalus after intracerebral hemorrhage (ICH) is a common and treatable complication. However, the long-term outcomes and factors for predicting hydrocephalus have seldom been studied. The goal of this study was to determine the long-term outcomes and analyze the risk factors of hydrocephalus after ICH. A consecutive series of 1342 patients with ICH were reviewed from 2010 to 2016 to identify significant risk factors for hydrocephalus. Patients with a first-ever ICH without any prior diagnosis of hydrocephalus after ICH were followed up for survival status and cause of death. Risk factors for hydrocephalus were evaluated by using logistic regression analysis. Out of a total of 1342 ICH patients, 120 patients (8.9%) had hydrocephalus. The risk factors for hydrocephalus (≤ 3 days) were infratentorial hemorrhage (p= 0.000), extension to ventricles (p= 0.000), greater ICH volume (p= 0.09), and hematoma expansion (p= 0.01). Extension to ventricles (p= 0.022) was the only independent risk factor for hydrocephalus (4–13 days), while extension to ventricles (p= 0.028), decompressive craniotomy (p= 0.032), and intracranial infection (p= 0.001) were independent predictors of hydrocephalus (≥ 14 days). Patients were followed up for a median of 5.2 years (IQR 3.3–7.3 years). Estimated all-cause mortality was significantly higher in the ICH patients with hydrocephalus than that without hydrocephalus (HR 3.22, 95% CI 2.42–4.28;p= 0.000). Fifty-nine (49.2%) died and 40 (33.3%) had a favorable outcome in patients with hydrocephalus. Of all deaths, 30.5% were from ICH and 64.4% from infection. Hydrocephalus is a frequent complication of ICH and most commonly occurs at the onset of ICH. Patients with hydrocephalus show relatively higher mortality. ClinicalTrials.gov Identifier: NCT02135783 (May 7, 2014)