Progression of traumatic intracerebral hemorrhage: A prospective observational study
Progression of traumatic intracerebral hemorrhage: A prospective observational study
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DOI：
10.1089/neu.2007.0385
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发表时间：
2008-06-01
影响因子：
4.2
通讯作者：
Marshall, Lawrence F.
中科院分区：
文献类型：
--
作者：
Narayan, Raj K.;Maas, Andrew I. R.;Marshall, Lawrence F.
初步证据表明，自发性（sICH）或创伤性（tICH）脑内出血通常会随着时间的推移而扩大。已经描述了sICH的出血扩展与临床结局之间的相关性。这项前瞻性、观察性研究的目的是描述通过连续计算机断层扫描（CT）测量的出血进展的时间特征，目的是更好地了解tICH出血进展的自然过程。还希望记录该患者组的基线不良事件（AE）特征。进行本研究的一个重要动机是为后续研究奠定基础，这些研究将检查新的全身止血剂在tICH中的作用。如果受试者在头部损伤后6小时内获得的基线CT扫描显示tICH病灶至少为2 mL，则入组受试者。在24和72 h重复CT扫描。记录临床结局和预定义的AE。数据显示，51%的受试者表现出tICH体积增加，并且大部分增加发生在早期。此外，较大的血肿表现出最大的扩张。在13%的受试者中确定了血栓栓塞并发症。本研究表明，大约一半的受试者在基线和24小时CT扫描之间发生tICH扩展。受伤后越早进行初始CT扫描，血肿在随后的扫描中扩大的可能性就越大。出血性扩张发生的时间范围为早期干预提供了机会，以限制具有不良预后影响的过程。
Preliminary evidence has shown that intracerebral hemorrhages, either spontaneous (sICH) or traumatic (tICH) often expand over time. An association between hemorrhage expansion and clinical outcomes has been described for sICH. The intent of this prospective, observational study was to characterize the temporal profile of hemorrhage progression, as measured by serial computed tomography (CT) scanning, with the aim of better understanding the natural course of hemorrhage progression in tICH. There was also a desire to document the baseline adverse event (AE) profile in this patient group. An important motive for performing this study was to set the stage for subsequent studies that will examine the role of a new systemic hemostatic agent in tICH. Subjects were enrolled if they had tICH lesions of at least 2 mL on a baseline CT scan obtained within 6 h of a head injury. CT scans were repeated at 24 and 72 h. Clinical outcomes and pre-defined AEs were documented. The data showed that 51% of the subjects demonstrated an increase in tICH volume, and that most of the increase occurred early. In addition, larger hematomas exhibited the greatest expansion. Thromboembolic complications were identified in 13% of subjects. This study demonstrates that tICH expansion between the baseline and 24-h CT scans occurred in approximately half of the subjects. The earlier after injury that the initial CT scan is obtained, the greater is the likelihood that the hematoma will expand on subsequent scans. The time frame during which hemorrhagic expansion occurs provides an opportunity for early intervention to limit a process with adverse prognostic implications.