Study On Influencing Factors Of Hematoma Enlargement In Early Spontaneous Intracerebral Hemorrhage

Objective:Spontaneous intracerebral hemorrhage?SICH?is the most dangerous subtype of stroke,with high early mortality and disability.Early hematoma enlargement?HE?occurs in about 20%-40%of patients with spontaneous intracerebral hemorrhage,which is the main determinant of disease progression and poor clinical outcome.This study will explore the related factors influencing the expansion of early hematomas in spontaneous cerebral hemorrhage.On the one hand,we can be more predictive of early hematoma enlargement;on the other hand,early treatment of some risk factors that can be artificially intervened may reduce the incidence of hematoma enlargement and improve the prognosis of patients with cerebral hemorrhage.Finally,the systemicity and comparability of HE-related predictors can be verified,and new influencing factors of HE can be found.Methods:The study subjects were patients with spontaneous intracerebral hemorrhage who met the inclusion criteria in the Department of Neurology,The First Affiliated Hospital?Yijishan Hospital?of Wannan Medical College from September2018 to October 2019.The basic data of the patients were collected including age,gender,History of smoking or drinking,history of hypertension,history of diabetes,records of laboratory parameters of patients including:hemoglobin,platelet count,triglycerides,total cholesterol,high density lipoprotein cholesterol?HDL-C?,low density lipoprotein cholesterol?LDL-C?,creatinine?Cr?,serum Ca²⁺,prothrombin time?PT?,partially activated thromboplastin time?APTT?,international standardized ratio?INR?;recording CT features of the skull:including the bleeding site of the skull CT,the volume of the hematoma,whether the hematoma is regular,and whether the hematoma density is uniform;all patients were reviewed at least one head CT at 36±12hour after admission.All patients were divided into hematoma enlargement group?HE group?and non-enlarged hematoma group?nHE group?according to whether hematoma expansion occurred.The SPSS21.0 software was used to analyzes the data statistically,and explores the relevant influencing factors of hematoma enlargement.Results:1.There was no significant difference in Age,gender,history of hypertension,history of diabetes,history of drinking,first systolic blood pressure,first diastolic blood pressure,serum Ca²⁺,creatinine,total cholesterol,HDL-C,LDL-C,PT,APTT,INR,triglycerides,platelet count between the nHE group and the HE group?P>0.05?.The proportion of smoking history in the enlarged hematoma group?42.31%?was higher than that in the non-enlarged hematoma group?19.23%?.The difference was statistically significant?P<0.05?.Binary logistic regression analysis showed that smoking history was an independent risk factor for HE.2.All the data were divided into regular groups of hematomas and irregular groups of hematomas according to whether the shape of hematomas was regular,There were 72cases of regular hematoma,of which 4 cases occurred HE?5.56%?;58 cases of irregular hematoma,of which 22 cases occurred HE?37.93%?.Chi-square test was used to obtain?2=21.044.The difference in the incidence of hematoma enlargement between the two groups was statistically significant?P<0.05?.It can be considered that the incidence of early hematoma enlargement in the irregularly shaped cerebral hemorrhage group was significantly higher than the regularly shape hematoma group.Binary logistic regression analysis showed that irregular hematoma morphology was an independent risk factor for HE.3.According to whether the density of hematoma is uniform,all the data are divided into a group of uniform density of hematoma and a group of uneven density of hematoma,There were 85 cases of uniform density of hematoma,of which 11 cases occurred HE?12.94%?;45 cases of uneven density of hematoma,of which 15 cases occurred HE?33.33%?.Chi-square test was used to obtain?2=7.647.The difference in the incidence of hematoma enlargement between the two groups was statistically significant?P<0.05?.It can be considered that the incidence of hematoma enlargement in the early stage of intracerebral hemorrhage with uneven hematoma density was significantly higher than the even hematoma density group.4.The median baseline hematoma volume of the nHE group was 10.15 ml?4.33,20.75?,and the median baseline hematoma volume of the HE group was 19.40ml?6.65,42.33?.The Mann-Whitney U test was used between the two groups.Test statistics Z=-2.654,progressive significance P<0.05,the difference is statistically significant,It can be considered that the baseline hematoma level of the HE group is different from the nHE group,and the baseline hematoma volume of the HE group is larger.5.All patients were divided into basal ganglia area group,thalamus group,brain lobe group,cerebellum or brain stem according to the bleeding site.There were 79 cases in the basal ganglia area group,of which 18 cases occurred HE?22.78%?;17 cases occurred in the thalamus group,4 cases occurred HE?23.53%?;20 cases in the brain lobe group,3 cases occurred HE?15%?;14 cases in the brainstem or cerebellum group,1 case occurred HE?7.14%?;the row×list data chi-square test was used,because the expected count of 3 cells?37.5%?was less than 5.The Fisher exact method was used to directly calculate the probability,and P>0.05 was obtained.Therefore,the probability of HE in different bleeding sites cannot be considered to be different.Conclusions:1.Smoking history and irregular hematoma morphology are independent risk factors for HE?P<0.05?;2.Hematoma density unevenness and large initial hematoma volume were related to HE?P<0.05?;3.The bleeding site cannot be used as a predictor of HE?P?0.05?;4.Hypertension history,diabetes history,drinking history,triglycerides,total cholesterol,hemoglobin,platelet count,HDL-C,LDL-C,Cr,Ca²⁺,PT,APTT,INR can not be used as predictors of HE?P?0.05?.