NEUROLOGIC DETERIORATION IN NONCOMATOSE PATIENTS WITH SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE
NEUROLOGIC DETERIORATION IN NONCOMATOSE PATIENTS WITH SUPRATENTORIAL INTRACEREBRAL HEMORRHAGE
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DOI：
10.1212/wnl.44.8.1379
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发表时间：
1994-08-01
期刊：
影响因子：
9.9
通讯作者：
MOHR, JP
中科院分区：
文献类型：
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作者：
MAYER, SA;SACCO, RL;MOHR, JP
Objective.确定幕上脑出血（ICH）非昏迷患者神经功能恶化（ND）的频率、时间进程和预测因素。背景ICH恶化的患者可能受益于旨在减少活动性出血或脑水肿所致占位效应的治疗。方法.我们分析了卒中数据库（SDB）中46例非昏迷（格拉斯哥昏迷量表[GCS]评分大于或等于8分）的ICH患者。所有受试者均在发病后24小时内（平均13.6小时）接受检查，并在住院期间前瞻性随访系列检查。ND定义为（1）GCS评分降低≥ 2分，（2）SDB虚弱评分增加≥ 1分，或（3）与内科或外科并发症无关的新功能缺损。结果：46例患者中15例发生ND（33%）。ND的频率是最大的第一个住院日（15例患者中的8例），此后逐渐下降。ND患者与稳定性缺陷患者相比，在初始CT检查中有更大的体积（平均体积，45 ml对16 ml，p <0.01）和更频繁地显示出明显的占位效应（60%对19%，p < 0.01），但在入院时的平均G;CS评分、平均血压或其他临床变量方面没有差异。血肿扩大被判定为15例患者中4例（27%）恶化的原因。ND患者30天病死率为47%，而稳定缺陷患者为3%（p = 0.001）。结论. ND发生在三分之一的幕上ICH非昏迷患者中，预后不良。CT显示的大血肿体积，而不是临床预测因素，可识别患者后续恶化的高风险。
Objective. To determine the frequency, time course, and predictors of neurologic deterioration (ND) in noncomatose patients with supratentorial intracerebral hemorrhage (ICH). Background. Patients with worsening ICH may benefit from therapy aimed at reducing mass effect due to active bleeding or cerebral edema. Methods. We analyzed 46 noncomatose (Glasgow Coma Scale [GCS] score greater than or equal to 8) patients with ICH in the Stroke Data Bank (SDB). All subjects were examined within 24 hours of onset (mean, 13.6 hours) and were prospectively followed with serial examinations during hospitalization. ND was defined as (1) a greater than or equal to 2-point decrease in the GCS score, (2) a greater than or equal to 1-point increase in the SDB weakness score, or (3) a new deficit, unrelated to medical or surgical complications. Results, ND occurred in 15 of 46 patients (33%). The frequency of ND was greatest on the first hospital day (eight of 15 patients) and decreased progressively thereafter. Patients with ND had larger hemorrhages (mean volume, 45 ml versus 16 ml, p < 0.01) and more frequently demonstrated marked mass effect (60% versus 19%, p < 0.01) on initial CT than those with stable deficits, but did not differ with regard to mean G;CS score, mean blood pressure, or other clinical variables on admission. Hematoma enlargement was judged to be the cause of worsening in four of 15 (27%) patients. Thirty-day case fatality was 47% in those with ND compared with 3% in those with stable deficits (p = 0.001). Conclusions. ND occurs in one-third of noncomatose patients with supratentorial ICH and carries a poor prognosis. Large hematoma volume on CT, rather than clinical predictors, identifies patients at high risk for subsequent worsening.