Study on the factors of paroxysmal sympathetic hyperactivity and its influence on the prognosis in patients with cerebral hemorrhage
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摘要: 目的 探讨重症自发性脑出血患者阵发性交感神经兴奋综合征(PSH)的发生因素及对预后的影响。方法 回顾性分析收住急诊ICU的重症自发性脑出血患者共108例，根据患者入ICU后PSH发病与否分为PSH组(n=38)和对照组(n=74)，统计并比较2组患者的临床资料包括ICU住院时间、总住院时间、气管切开率、机械通气时间、发病28 d后改良Rankin量表(mRS)评分及生存情况，并通过Logistic回归分析对PSH发生进行各个变量风险评估。结果 PSH组的GCS评分、APACHEⅡ评分高于对照组(P< 0.05)。PSH组的丘脑、脑干部位出血发生率高于对照组(P< 0.05)。单因素及多因素Logistic回归分析显示，GCS评分、脑干出血是PSH患者发生的独立风险因素(P< 0.05)。PSH组患者的ICU住院时间、机械通气时间均长于对照组(P< 0.05)，且PSH组的气管切开率高于对照组(P< 0.05)，但2组患者的总住院时间、病死率比较差异无统计学意义(P>0.05)。发病28 d后PSH组患者的mRS评分高于对照组(P< 0.05)。结论 对于脑出血患者其昏迷程度以及出血部位是PSH发生的独立危险因素，且发生PSH的患者具有更长的ICU住院时间、更高的气管切开发生率以及较差的短期神经功能恢复情况。
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关键词:
- 阵发性交感神经兴奋综合征 /
- 脑出血 /
- 预后
Abstract: Objective To investigate the factors of paroxysmal sympathetic hyperactivity(PSH) and its influence on the prognosis in patients with severe cerebral hemorrhage.Methods A total of 108 patients with severe spontaneous intracerebral hemorrhage admitted to ICU were retrospectively analyzed. According to the onset of PSH in ICU, the patients were divided into PSH group(n=38) and control group(n=74). The clinical data of the two groups were analyzed and compared, including length of ICU stay, total length of stay, rate of tracheotomy, duration of mechanical ventilation, modified rankin scale(mRS) score and survival after 28 days of onset. Logistic regression analysis was used to evaluate the risk of PSH occurrence in all variables.Results GCS score and APACHEⅡ score in PSH group were higher than those in control group(P< 0.05). The incidence of thalamus and brainstem hemorrhage in PSH group was higher than that in control group(P< 0.05). Univariate and multivariate Logistic regression analysis showed that GCS score and brainstem hemorrhage were independent risk factors for PSH patients(P< 0.05). The length of ICU stay and mechanical ventilation time in PSH group were longer than those in control group(P< 0.05), and the rate of tracheotomy in PSH group was higher than that in control group(P< 0.05), but there were no significant differences in total length of stay and mortality between the two groups(P>0.05). mRS score in PSH group was higher than that in control group 28 days after onset(P< 0.05).Conclusion Coma degree and bleeding site are independent risk factors for PSH in patients with intracranial hemorrhage, and patients with PSH have a longer ICU stay, a higher incidence of tracheotomy, and a poorer short-term neurological function recovery.-
Key words:
- paroxysmal sympathetic hyperactivity /
- intracranial hemorrhage /
- prognosis
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表 1 2组基线资料比较
X±S，例(%) 基线资料 对照组(n=74) PSH组(n=38) t/χ2 P 年龄/岁 51.35±12.24 58.54±13.17 1.26 0.212 性别 男 38(51.35) 20(52.63) 2.76 0.097 女 36(48.65) 18(47.37) BMI 23.65±4.16 24.35±4.43 1.66 1.117 基础疾病 糖尿病 10(13.51) 6(15.79) 1.78 0.182 高血压 19(25.68) 11(28.95) 2.67 0.102 冠心病 8(10.81) 5(13.16) 1.78 0.182 慢性肺疾病 7(9.46) 4(10.53) 2.14 0.143 APACHEⅡ评分/分 22.56±5.67 26.26±6.19 2.29 0.024 GCS评分/分 6.65±2.35 4.36±1.89 2.89 0.004 入科时生命体征 心率/(次·min-1) 92.34±18.15 95.45±20.25 0.97 0.335 呼吸/(次·min-1) 19.26±4.56 21.25±5.18 1.24 0.217 收缩压/mmHga) 145.15±45.56 153.25±49.52 1.75 0.080 舒张压/mmHg 76.58±12.35 78.67±13.29 1.45 0.150 脉氧/% 98.67±8.96 98.47±9.36 1.15 0.250 体温/℃ 36.87±7.47 36.67±6.47 1.87 0.064 脑出血部位 基底节 25(33.78) 11(28.95) 2.14 0.143 丘脑 8(10.81) 6(15.79) 4.87 0.027 脑干 11(14.86) 9(23.68) 6.45 0.011 小脑 9(12.16) 4(10.53) 1.44 0.230 脑室 8(10.81) 5(13.16) 1.62 0.203 蛛网膜下腔 9(12.16) 3(7.89) 1.24 0.266 其他 4(5.41) 1(2.63) 1.34 0.247 注：a)1 mmHg=0.133 kPa 
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表 2 单因素Logistic回归分析
变量 P OR 95%CI 年龄 0.008 1.235 1.027~5.265 性别 0.075 0.969 0.945~2.514 GCS评分 < 0.01 0.735 0.498~0.899 APACHEⅡ评分 0.045 1.326 1.109~1.469 丘脑出血 0.015 1.269 1.135~1.420 脑干出血 < 0.01 1.567 1.245~1.783
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表 3 多因素Logistic回归分析
变量 P OR 95%CI GCS评分 0.023 0.786 0.456~0.978 APACHEⅡ评分 0.145 1.013 0.784~1.152 脑干出血 0.003 1.478 1.138~1.549 丘脑出血 0.078 1.043 0.765~1.328
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表 4 2组患者住院结局和预后指标比较
X±S，例(%) 指标 对照组(n=74) PSH组(n=38) t/χ2 P ICU住院时间/d 12.35±2.45 17.68±3.75 3.24 0.002 总住院时间/d 24.45±4.15 29.48±6.68 1.35 0.179 机械通气时间/d 15.65±4.36 20.24±4.78 2.05 0.043 气管切开 42(56.76) 28(73.68) 4.88 0.027 死亡 24(32.43) 14(36.84) 1.65 0.102 出院时mRS/分 3.87±0.67 4.96±0.89 2.74 0.007
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