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目的研究脑出血迟发性脑水肿与纤维蛋白原(FIB)等因素的相互联系,并探讨对脑出血预后的影响。方法回顾性分析本院2008年1月～2011年2月接受内科保守治疗的非外伤性急性脑出血60例,其中并发迟发性脑水肿29例,未发生迟发性脑水肿31例。于发病后连续3周监测FIB值等指标,并同时期行头颅CT检查,动态观察血肿及其周围水肿的变化。行χ2检验比较迟发性脑水肿组与未发生组间FIB的升高率;logistic回归分析迟发性脑水肿与各指标的相关性,并采用多元逐步COX模型分析脑出血预后的相关影响因素。结果迟发性脑水肿组较未发生组FIB值明显升高(P<0.005);FIB升高、脑出血量大、吸烟、高血压病史与迟发性脑水肿相关(P<0.05);迟发性脑水肿、持续升高的FIB和高血压病影响脑出血的预后,其P值均<0.05,有统计学意义。结论脑出血者FIB持续升高、脑出血量大、吸烟、高血压与迟发性脑水肿的发生密切相关,迟发性脑水肿、FIB升高和高血压病影响预后,对疾病恢复有不良影响。
Objective To study the relationship between delayed cerebral edema and fibrinogen (FIB) in cerebral hemorrhage and to explore the influence on the prognosis of cerebral hemorrhage. Methods A retrospective analysis of our hospital from January 2008 to February 2011 conservative treatment of non-traumatic acute traumatic cerebral hemorrhage in 60 cases, of which 29 cases of delayed onset cerebral edema, 31 cases did not occur delayed cerebral edema. Three weeks after the onset of monitoring FIB values and other indicators, and at the same time line head CT examination, dynamic observation of hematoma and its changes around the edema. The Chi-square test was used to compare the rate of FIB increase between late-onset brain edema group and non-occurred group. Logistic regression analysis was used to analyze the correlation between late-onset brain edema and each index. Multivariate stepwise COX model was used to analyze the related factors . Results Compared with the non-onset cerebral edema group, the FIB value was significantly increased (P <0.005); the FIB was increased, the amount of cerebral hemorrhage was large, smoking and the history of hypertension were associated with delayed cerebral edema (P <0.05) Cerebral edema, persistent elevated FIB and hypertension affect the prognosis of cerebral hemorrhage, the P values were <0.05, with statistical significance. Conclusions FIB in patients with intracerebral hemorrhage continues to increase, and the amount of cerebral hemorrhage is large. Smoking and hypertension are closely related to the occurrence of delayed cerebral edema. Delayed cerebral edema, elevated FIB and the prognosis of hypertension affect the disease recovery influences.