Analysis Of Risk Factors For Perihematomal Edema Expansion Following Hypertensive Intracerebral Hemorrhage

【Objective】To investigate the independent risks of Perihematoma Edema expansion Following Hypertensive Intracerebral Hemorrhage.【Methods】This was a retrospective study of 195 inpatients from First affiliated hospital of fujian medical university,with hypertensive intracerebral hemorrhage from May 2012 to March 2015.The basic information including age,gender and days of hospitalization,blood pressure value,NIHSS at admission and at discharge,CT images of these inpatients and interventions were full collected.Hematoma volumes and total lesions volumes were measured from CT images,by the Coniglobus formula.The expansion of perihematoma edema was defined when total lesions value T2 was larger then total lesions value T1.Blood pressure variability indicating days variability was quantified by the standard deviation(SD)、 coefficient of variation(CV).For they might both positively correlated with mean levels of blood pressure,a further transformative parameter,variability independent of mean(VIM)was calculated.We estimated associations between blood pressure variability and outcomes with logistic and proportional odds regression models.The key parameter for blood pressure variability was standard deviation(SD)of systolic blood pressure,categorised into quintiles.Binary logistic regression analysis was performed in the data of the blood pressure variability parameters,mean blood pressure,Hospitalization days,drugs used during the period of observation and so on,using foreward stepwise regression to access the independent risk factors of perihematoma edema.【Results】By logistic regression,we found variability independent of mean of systolic blood pressure(SBP-VIM)(tri-sectional quantiles OR 3.583,95%CI 1.657~7.748,P 0.001)、mean systolic blood(SBP-Mean)(tri-sectional quantiles OR 3.321,95%CI 1.534~7.188,P 0.002)、standard deviation of systolic blood(SBP-SD)(tri-sectional quantiles OR 4.637,95%CI 2.139~10.052 P0.000)and the Coefficient of Variation of systolic blood(SBP-CV)(tri-sectional quantiles OR 3.454,95%CI 1.626 ~ 7.339 P=0.001)had significant association with the Perihematoma Edema expansion.The NIHSS scale at admission(tri-sectional quantiles OR 0.322,95%CI 0.149 ~ 0.697 P=0.004)is nagetively related to the Perihematoma Edema expansion.There was no correlation between age、gender、hemetoma volume、use of norvase、mannital、glycerin fructosediuretic、RAS classes of antihypertensive agents、mean levels of diastolic blood pressure(DBP-Mean)、standard deviation of diastolic blood(DBP-SD)、blood pressure variability the Coefficient of Variation of diastolic blood(DBP-CV)、variability independent of mean of diastolic blood pressure(VIM-DBP)and Perihematoma Edema expansion.【Conclusion】The mean systolic blood pressure and systolic blood pressure variability seem to predict the expansion of perihematoma edema in patients with acute hpertensive intracerebral hemorrhage.Smoothly lower systolic blood pressure may reduce the occurrence of perihematoma expansion in patients with hpertensive intracerebral hemorrhage.The NIHSS scale at admission is nagetively related to the Perihematoma Edema expansion,further researchs are needed to confirm whether it is the protective factor of the Perihematoma Edema expansion.