Predictors of late neurological deterioration after spontaneous intracerebral hemorrhage.
Predictors of late neurological deterioration after spontaneous intracerebral hemorrhage.
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DOI：
10.1007/s12028-013-9894-2
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发表时间：
2013-12
影响因子：
3.5
通讯作者：
James, Michael L.
中科院分区：
文献类型：
--
作者：
Sun, Weiping;Pan, Wenqin;Kranz, Peter G.;Hailey, Claire E.;Williamson, Rachel A.;Sun, Wei;Laskowitz, Daniel T.;James, Michael L.
虽然脑出血（ICH）是一种常见的脑血管疾病，但对血肿形成后48小时以上导致神经功能恶化的因素知之甚少。本研究的目的是描述自发性ICH患者迟发性神经功能恶化（LND）的发生率、后果和相关因素。使用2007年7月至2012年6月的杜克大学医院神经科学重症监护室数据库，149例自发性幕上ICH连续患者队列符合分析标准。LND定义为在ICH症状发作后48 h至1周内格拉斯哥昏迷量表评分降低2分或2分以上或死亡。不良结局定义为出院时改良兰金量表评分>2分。43例受试者（28.9%）发生LND。逻辑回归模型显示血肿体积（OR = 1.017，95% CI 1.003-1.032，p = 0.019），脑室内出血（OR = 2.519，95%CI 1.142-5.554，p = 0.022）和入院时血糖（OR = 2.614，95%CI 1.146-5.965，p = 0.022）作为LND的独立预测因素。校正ICH评分后，LND与不良结局独立相关（OR = 4.000，95%CI 1.280-12.500，p = 0.017）。在65例随访计算机断层扫描图像的受试者中，中线移位增加作为脑水肿的替代，与LND独立相关（OR = 3.822，95% CI 1.157-12.622，p = 0.028）。LND是ICH患者的常见现象;此外，LND似乎会影响结局。LND的独立预测因素包括血肿体积、脑室内出血和入院时血糖。血肿周围水肿的进展可能是LND的机制之一。
Although intracerebral hemorrhage (ICH) is a common form of cerebrovascular disease, little is known about factors leading to neurological deterioration occurring beyond 48 h after hematoma formation. The purpose of this study was to characterize the incidence, consequences, and associative factors of late neurological deterioration (LND) in patients with spontaneous ICH. Using the Duke University Hospital Neuroscience Intensive Care Unit database from July 2007 to June 2012, a cohort of 149 consecutive patients with spontaneous supratentorial ICH met criteria for analysis. LND was defined as a decrease of two or more points in Glasgow Coma Scale score or death during the period from 48 h to 1 week after ICH symptom onset. Unfavorable outcome was defined as a modified Rankin Scale score of >2 at discharge. Forty-three subjects (28.9 %) developed LND. Logistic regression models revealed hematoma volume (OR = 1.017, 95 % CI 1.003–1.032, p = 0.019), intraventricular hemorrhage (OR = 2.519, 95 % CI 1.142–5.554, p = 0.022) and serum glucose on admission (OR = 2.614, 95 % CI 1.146–5.965, p = 0.022) as independent predictors of LND. After adjusting for ICH score, LND was independently associated with unfavorable outcome (OR = 4.000, 95 % CI 1.280–12.500, p = 0.017). In 65 subjects with follow-up computed tomography images, an increase in midline shift, as a surrogate for cerebral edema, was independently associated with LND (OR = 3.822, 95 % CI 1.157–12.622, p = 0.028). LND is a common phenomenon in patients with ICH; further, LND appears to affect outcome. Independent predictors of LND include hematoma volume, intraventricular hemorrhage, and blood glucose on admission. Progression of perihematomal edema may be one mechanism for LND.
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