中国脑出血医疗现状及死亡相关因素分析

摘要/Abstract

摘要：

【摘要】目的系统研究中国脑出血患者3个月、1年死亡的相关因素。方法本研究收集自2007年9月～2008年8月中国国家卒中登记数据库连续登记的来自全国27个省、4个直辖市及香港的132家医院的5136例发病14 d以内脑出血住院患者的人口学信息、临床资料、住院期间治疗及临床结局进行系统分析。采用Cox回归分析3个月、1年死亡的相关因素。结果脑出血3个月及1年的病死率分别为20.0%和26.1%。院内降压治疗是降低3个月［危险比（hazard ratio，HR）0.79，95%可信区间（confidence interval，CI）0.66～0.95］及1年（HR 0.84，95%CI 0.72～0.98）死亡的相关因素。年龄［3个月（66～75岁：HR 1.54，95%CI 1.08～2.20；≥76岁：HR 2.13，95%CI 1.49～3.04）；1年（66～75岁：HR 1.62，95%CI 1.19～2.21；≥76岁：HR 2.43，95%CI 1.78～3.31）］，入院格拉斯哥昏迷量表评分［3个月（9～12分：HR 2.36，95%CI 1.66～3.36；3～8分：HR 5.11，95%CI 3.67～7.11）；1年（9～12分：HR 2.23，95%CI 1.67～2.97；3～8分：HR 4.41，95%CI 3.36～5.77）］，入院美国国立卫生研究院卒中量表评分≥15（3个月：HR 1.74，95%CI 1.28～2.38；1年：HR 1.70，95%CI 1.31～2.22），血糖（3个月：HR 1.06，95%CI 1.01～1.10；1年：HR 1.05，95%CI 1.02～1.09），血肿体积［3个月（幕上30～60 ml：HR 1.57，95%CI 1.22～2.02；幕上＞60 ml：HR 2.42，95%CI 1.86～3.14；幕下≤10 ml：HR 2.07，95%CI 1.51～2.85；幕下10～20 ml：HR 2.70，95%CI 1.64～4.45；幕下＞20 ml：HR 2.40，95%CI 1.41～4.09；1年（幕上30～60 ml：HR 1.55，95%CI 1.24～1.93；幕上＞60 ml：HR 2.48，95%CI 1.96～3.14；幕下≤10 ml：HR 1.86，95%CI 1.41～2.46；幕下10～20 ml：HR 2.38，95%CI 1.53～3.72；幕下＞20 ml：HR 2.42，95%CI 1.49～3.92）］，血肿破入脑室（3个月：HR 1.65，95%CI 1.37～1.99；1年：HR 1.47，95%CI 1.25～1.73），监护室治疗（3个月：HR 1.53，95%CI 1.25～1.87；1年：HR 1.56，95%CI 1.30～1.86），再发卒中（3个月：HR 2.71，95%CI 1.99～3.70；1年：HR 2.62，95%CI 1.98～3.47）及癫痫发作（3个月：HR 1.57，95%CI 1.05～2.35；1年：HR 1.57，95%CI 1.10～2.26）是3个月和1年死亡危险因素。静脉应用脱水药物治疗是3个月（HR 1.86，95%CI 1.04～3.31）死亡危险因素。结论加强脑出血患者住院期间的降压治疗，控制血糖，早期诊断并处理癫痫发作及再发卒中，参照脑出血治疗指南规范应用脱水药物，并对其他影响预后的危险因素及时发现及适当干预有望改善中国脑出血患者的长期预后。

文章导读： 通过对中国最大脑出血登记研究数据库的资料进行分析，了解我国脑出血医疗现状，为提高脑出血医疗质量提供依据。

关键词: 脑出血; 危险因素; 病死率; 预后

Abstract:

【Abstract】 Objective To systematically analyze the risk factors associated with 3-month, 1-year case fatality of intracerebral hemorrhage in China. Methods China National Stroke Registry (CNSR) is a national prospective registry study. A total of 132 hospitals representing 27 provinces, 4 municipalities and Hong Kong in China have been selected as the study sites. From September 2007 to August 2008, ICH patients presenting within 14 days after the onset of symptoms were registered in the CNSR. Data on demographics, treatment patterns and outcome of the ICH patients were analyzed. Cox proportional hazards model was used to determine the risk factors of 3-month and 1-year case fatality.

Results ICH case fatality was 20.0% and 26.1% at 3-month and 1-year, respectively. Antihypertensive therapy in hospital was associated with decreased 3-month (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.66~0.95) and 1-year (HR 0.84, 95%CI 0.72~0.98)case fatality. Age (3-month [66~75 years old:HR 1.54, 95%CI 1.08~2.20; ≥76 years old:HR 2.13, 95%CI 1.49~3.04]; 1-year [66~75 years old:HR 1.62, 95%CI 1.19~2.21; ≥76 years old:HR 2.43, 95%CI 1.78~3.31]), Glasgow Coma Score (GCS) at admission (3-month [9~12:HR 2.36, 95%CI 1.66~3.36; 3~8:HR 5.11, 95%CI 3.67~7.11]; 1-year [9~12:HR 2.23, 95%CI 1.67~2.97;3~8:HR 4.41, 95%CI 3.36~5.77]), National Institutes of Health Stroke Scale (NIHSS) at admission≥15 (3-month:HR 1.74, 95%CI 1.28~2.38; 1-year:HR 1.70, 95%CI 1.31~2.22), serum glucose at admission (3-month:HR 1.06, 95%CI 1.01~1.10; 1-year:HR 1.05, 95%CI 1.02~1.09), hematoma volume (3-month [supratentorial 30~60 ml:HR 1.57, 95%CI 1.22~2.02; supratentorial>60 ml:HR 2.42, 95%CI 1.86~3.14; subtentorial ≤10 ml:HR 2.07, 95%CI 1.51~2.85; subtentorial 10~20 ml:HR 2.70, 95%CI 1.64~4.45; subtentorial>20 ml:HR 2.40, 95%CI 1.41~4.09]; 1-year [supratentorial 30~60 ml:HR 1.55, 95%CI 1.24~1.93; supratentorial>60 ml:HR 2.48, 95%CI 1.96~3.14; subtentorial≤10 ml:HR 1.86, 95%CI 1.41~2.46; subtentorial 10~20 ml:HR 2.38, 95%CI 1.53~3.72; subtentorial >20 ml:HR 2.42, 95%CI 1.49~3.92]), intraventricular extension of hematoma (3-month:HR 1.65, 95%CI 1.37~1.99; 1-year:HR 1.47, 95%CI 1.25~1.73), intensive care unit care (3-month:HR 1.53, 95%CI 1.25~1.87; 1-year:HR 1.56, 95%CI 1.30~1.86), complications of recurrent stroke (3-month:HR 2.71, 95%CI 1.99~3.70; 1-year:HR 2.62, 95%CI 1.98~3.47) or seizure (3-month:HR 1.57, 95%CI 1.05~2.35; 1-year:HR 1.57, 95%CI 1.10~2.26) were associated with increased case fatality of 3-month and 1-year. Intravenous hemodiluting agent use in hospital was associated with high case fatality of 3-month (HR 1.86, 95%CI 1.04~3.31) but not that of 1-year. Conclusion Antihypertensive therapy in hospital, glucose control, early identification and treatment of complications of seizure or recurrent stroke and use of hemodiluting agents according to guideline should be emphasized to improve the long-term outcome of ICH in Chinese population.

Key words: Intracerebral hemorrhage; Risk factor; Case fatality; Outcome

中国脑出血医疗现状及死亡相关因素分析. 中国脑出血医疗现状及死亡相关因素分析[J]. 中国卒中杂志, 2013, 8(09): 703-711.

WANG Wen-Juan, WANG Chun-Xue, YANG Zhong-Hua, LIU Li-Ping, LU Jing-Jing, WANG An-Xin, ZHAO Xing-Quan.. Management and Variables Associated with Case Fatality of Intracerebral Haemorrhage in China[J]. Chinese Journal of Stroke, 2013, 8(09): 703-711.

参考文献

1 Balami JS, Buchan AM. Complications of intracerebral haemorrhage[J]. Lancet Neurol, 2012, 11:101-118.

2 Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 population-based studies:A systematic review[J]. Lancet Neurol, 2009, 8:355-369.

3 van Asch CJ, Luitse MJ, Rinkel GJ, et al. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin:A systematic review and meta-analysis[J]. Lancet Neurol, 2010, 9:167-176.

4 Yang QD, Niu Q, Zhou YH, et al. Incidence of cerebral hemorrhage in the Changsha community. A prospective study from 1986 to 2000[J]. Cerebrovasc Dis, 2004, 17:303-313.

5 Zhang LF, Yang J, Hong Z, et al. Proportion of different subtypes of stroke in China[J]. Stroke, 2003, 34:2091-2096.

6 Lovelock CE, Molyneux AJ, Rothwell PM. Change in incidence and aetiology of intracerebral haemorrhage in Oxfordshire, UK, between 1981 and 2006:A population-based study[J]. Lancet Neurol, 2007, 6:487-493.

7 Islam MS, Anderson CS, Hankey GJ, et al. Trends in incidence and outcome of stroke in Perth, Western Australia during 1989 to 2001:The Perth community stroke study[J]. Stroke, 2008, 39:776-782.

8 Wei JW, Huang Y, Wang JG, et al. Current management of intracerebral haemorrhage in China:A national, multi-centre, hospital register study[J]. BMC Neurol, 2011, 11:16.

9 Wang Y, Cui L, Ji X, et al. The China National Stroke Registry for patients with acute cerebrovascular events:Design, rationale, and baseline patient characteristics[J]. Int J Stroke, 2011, 6:355-361.

10 No authors listed. Stroke--1989. Recommendations on stroke prevention, diagnosis, and therapy. Report of the who task force on stroke and other cerebrovascular disorders[J]. Stroke, 1989, 20:1407-1431.

11 Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes[J]. Stroke, 1996, 27:1304-1305.

12 Ruiz-Sandoval JL, Chiquete E, Romero-Vargas S, et al. Grading scale for prediction of outcome in primary intracerebral hemorrhages[J]. Stroke, 2007, 38:1641-1644.

13 Weimar C, Weber C, Wagner M, et al. Management patterns and health care use after intracerebral hemorrhage. a cost-of-illness study from a societal perspective in Germany[J]. Cerebrovasc Dis, 2003, 15:29-36.

14 McGuire AJ, Raikou M, Whittle I, et al. Long-term mortality, morbidity and hospital care following intracerebral hemorrhage:an 11-year cohort study[J]. Cerebrovasc Dis, 2007, 23:221-228.

15 Christensen MC, Munro V. Ischemic stroke and intracerebral hemorrhage:the latest evidence on mortality, readmissions and hospital costs from Scotland[J]. Neuroepidemiology, 2008, 30:239-246.

16 Janneke VB, Caroline EL, Charlotte C, et al. Outcome after spontaneous and arteriovenous malformation-related intracerebral haemorrhage:population-based studies[J]. Brain, 2009, 132:537-543.

17 Rost NS, Smith EE, Chang Y, et al. Prediction of functional outcome in patients with primary intracerebral hemorrhage:The FUNC score[J]. Stroke, 2008, 39:2304-2309.

18 Hemphill JC 3rd, Farrant M, Neill TA Jr. Prospective validation of the ich score for 12-month functional outcome[J]. Neurology, 2009, 73:1088-1094.

19 Yu JG, Zhou RR, Cai GJ. From hypertension to stroke:Mechanisms and potential prevention strategies[J]. CNS Neurosci Ther, 2011, 17:577-584.

20 Qureshi AI, Ezzeddine MA, Nasar A, et al. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States[J]. Am J Emerg Med, 2007, 25:32-38.

21 Qureshi AI. Antihypertensive treatment of acute cerebral hemorrhage[J]. Crit Care Med, 2010, 38:637-648.

22 Anderson CS, Huang Y, Arima H, et al. Effects of early intensive blood pressure-lowering treatment on the growth of hematoma and perihematomal edema in acute intracerebral hemorrhage:The intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT)[J]. Stroke, 2010, 41:307-312.

23 Anderson CS, Huang Y, Wang JG, et al. Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT):A randomised pilot trial[J]. Lancet Neurol, 2008, 7:391-399.

24 Morgenstern LB, Hemphill JC 3rd, Anderson C, et al. Guidelines for the management of spontaneous intracerebral hemorrhage:A guideline for healthcare professionals from the American Heart Association/ American Stroke Association[J]. Stroke, 2010, 41:2108-2129.

25 Steiner T, Kaste M, Forsting M, et al. Recommendations for the management of intracranial haemorrhage-part I:Spontaneous intracerebral haemorrhage. The European Stroke Initiative Writing Committee and the Writing Committee for the EUSI executive committee[J]. Cerebrovasc Dis, 2006, 22:294-316.

26 Claassen J, Jette N, Chum F, et al. Electrographic seizures and periodic discharges after intracerebral hemorrhage[J]. Neurology, 2007, 69:1356-1365.

27 Naidech AM, Bernstein RA, Bassin SL, et al. How patients die after intracerebral hemorrhage[J]. Neurocrit Care, 2009, 11:45-49.

28 Zahuranec DB, Brown DL, Lisabeth LD, et al. Early care limitations independently predict mortality after intracerebral hemorrhage[J]. Neurology, 2007, 68:1651-1657.

29 Qureshi AI, Mendelow AD, Hanley DF. Intracerebral haemorrhage[J]. Lancet, 2009, 373:1632-1644.

30 Misra UK, Kalita J, Ranjan P, et al. Mannitol in intracerebral hemorrhage:A randomized controlled study[J]. J Neurol Sci, 2005, 234:41-45.

[1]	王恺闻, 卢宝全, 吴秀玲, 马佳丽. 基于MRA评估基底动脉闭塞预后评分预测非重症基底动脉闭塞患者预后效能的研究 [J]. 中国卒中杂志, 2022, 17(12): 1335-1342.
[2]	宋彦丽, 林杰, 武一平, 李晓晶, 刘改芬, 夏文静, 张玉英, 张晓林, 吕晨冉, 周红, 李凯, 薛斌, 陈玲玲, 张忠波, 彭晓. 邯郸市居民心脑血管病危险因素的流行现状及高血压知晓率、治疗率和控制率的影响因素研究 [J]. 中国卒中杂志, 2022, 17(12): 1360-1365.
[3]	吴晓莉, 刘丽旭. 肥胖对卒中预后的影响[J]. 中国卒中杂志, 2022, 17(12): 1391-1395.
[4]	郑占军, 赵性泉. 脑小血管病影像学标志物与自发性高血压脑出血的相关性研究进展[J]. 中国卒中杂志, 2022, 17(12): 1396-1402.
[5]	邓宇含, 刘爽, 王子尧, 汪雨欣, 刘宝花. 基于结构化数据和机器学习模型预测普通人群卒中发病风险的系统评价和meta分析 [J]. 中国卒中杂志, 2022, 17(11): 1189-1197.
[6]	胡红梅, 杨磊, 于玲, 秦伟, 白明悦, 胡文立. 急性单发小脑小梗死的临床特征 [J]. 中国卒中杂志, 2022, 17(11): 1221-1226.
[7]	付江红, 陈树耿, 束小康, 蒋泽武, 魏栋帅, 贾杰. 脑机接口训练对卒中后感觉障碍患者运动功能恢复的影响：1项探索性研究[J]. 中国卒中杂志, 2022, 17(10): 1051-1057.
[8]	程实, 李静, 郭军平, 胡爱香, 于鑫玮, 韩玮, 梁瑛, 张越巍, 冀瑞俊. 急性卒中患者住院期间感染的临床特征及危险因素分析[J]. 中国卒中杂志, 2022, 17(10): 1065-1070.
[9]	赵永瑞, 刘展会. 弥散张量成像在缺血性卒中患者运动功能预后评估中的研究进展[J]. 中国卒中杂志, 2022, 17(10): 1114-1119.
[10]	徐蔚海, 李顺, 程安琪. 青年卒中的诊治：勿过激[J]. 中国卒中杂志, 2022, 17(09): 915-918.
[11]	张一歌, 张婉, 张璐阳, 王鑫, 丁澜, 王玉莹, 裴璐璐, 方慧, 许予明, 宋波. 责任动脉闭塞与夹层相关缺血性卒中复发的相关性分析[J]. 中国卒中杂志, 2022, 17(09): 932-936.
[12]	符荷琯, 沈栩轩, 徐佳丽, 张厚地, 李斌, 邹正兴, 冯捷, 段炼, 韩聪. 青年烟雾病患者的卒中类型及危险因素分析 [J]. 中国卒中杂志, 2022, 17(09): 937-943.
[13]	吕微, 王安心, 田雪, 张晓丽, 许玉园, 孟霞. 心血宁胶囊对伴高同型半胱氨酸水平缺血性卒中患者短期功能预后的影响[J]. 中国卒中杂志, 2022, 17(09): 972-976.
[14]	豆朋宇, 班梦苛, 贵永堃, 包万利, 张平. 脑白质高信号与孤立大脑中动脉重度狭窄或闭塞患者临床预后的相关性研究[J]. 中国卒中杂志, 2022, 17(09): 985-990.
[15]	范琳琳, 田飞. 以癫痫持续状态和脑出血为特征的胶质母细胞瘤1例并文献复习[J]. 中国卒中杂志, 2022, 17(09): 1002-1006.