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目的探讨急性脑出血死亡的危险因素,积极进行早期干预,降低病死率。方法 128例发病6 h的急性脑出血患者,收缩压在150~220 mm Hg之间,记录患者一周内不同时间段血压(到院急诊,入院当时,入院后24 h内每隔6 h及其后每日2次血压),入院时及(24±3)h的CT复查血肿大小和神经功能缺损程度(GCS,NIHSS)评分,随访90 d m RS评分,分析死亡的相关因素。结果 (1)128例患者中90 d死亡11.7%,其中死亡在24 h内占6.7%,一周内达40%。(2)90 d死亡与发病年龄密切相关,死亡者与生存者平均年龄分别为(75.53±15.18)岁和(62.79±13.25)岁,有显著差异(P<0.001);但死亡与性别无关。(3)90 d死亡者与生存者,急诊血压分别为(181.87±18.30)mm Hg和(184.39±18.65)mm Hg(P=0.945);入院当时血压分别为(180.33±17.17)mm Hg和(174.72±16.13)mm Hg(P=0.788),均无关;但死亡与入院后30 min、45 min及6 h血压有显著相关(r=0.263,P=0.003),血压越高,死亡率越高。(4)死亡与发病前后24 h的血肿体积量密切有关(P<0.01),与血肿部位无关。(5)将年龄、性别和入院血肿量、神经功能评分及血压进行多因素二元Logistic回归分析,发现年龄[OR:1.082,95%CI(1.018~1.149),P=0.011]和血肿体积[OR:1.011,95%CI(1.000~1.023),P=0.046]是死亡的独立危险因素。结论高龄和血肿体积增大是高血压脑出血死亡的重要危险因素。积极控制血肿体积,可以降低死亡率。
Objective To investigate the risk factors of death from acute cerebral hemorrhage, actively carry out early intervention and reduce mortality. Methods A total of 128 patients with acute cerebral hemorrhage who developed for 6 hours had systolic blood pressure between 150 and 220 mm Hg. The patients’ blood pressure was recorded at different times of the week (admission emergency, admission at 24 hours after admission, (Twice daily blood pressure). At the time of admission and (24 ± 3) h after CT examination, the size of hematoma and the degree of neurological deficit (GCS, NIHSS) were scored. The 90 dm RS scores were followed up to analyze the related factors of death. Results (1) In 128 cases, 11.7% of them died at 90 days. The death rate was 6.7% within 24 h and 40% within one week. (2) The 90-day mortality was closely related to the age of onset. The mean age of death and survivors was (75.53 ± 15.18) years and (62.79 ± 13.25) years, respectively, with significant difference (P <0.001). (3) The emergency blood pressure was (181.87 ± 18.30) mm Hg and (184.39 ± 18.65) mm Hg respectively (P = 0.945) after 90 d death and survivors; the blood pressure at the time of admission were (180.33 ± 17.17) mm Hg and 174.72 ± 16.13 mm Hg (P = 0.788). However, death was significantly associated with blood pressure at 30 min, 45 min and 6 h after admission (r = 0.263, P = 0.003). The higher the blood pressure, the higher the mortality rate . (4) The death was closely related to the volume of hematoma 24 h before and after the onset (P <0.01), but not with the hematoma site. (5) Multivariate Logistic regression analysis of age, sex and admission hematoma volume, neurological function score and blood pressure showed that the age [OR: 1.082,95% CI 1.018-1.1419, P = 0.011] and hematoma volume OR: 1.011, 95% CI (1.000 to 1.023), P = 0.046] were independent risk factors for death. Conclusions Age and hematoma enlargement are important risk factors of death from hypertensive intracerebral hemorrhage. Active control of hematoma volume, can reduce mortality.