| Background and Objective:Cerebral hemorrhage is one of the worst prognostic diseases of stroke.There are many reasons affecting the prognosis of cerebral hemorrhage,and cerebral edema is one of them.However,the pathogenesis of cerebral edema after intracerebral hemorrhage is complicated and affected by many factors.This study investigated whether elevated plasma osmotic pressure affects the absorption of perihematoma edema to predict the prognosis of cerebral hemorrhage.Methods:Clinical data of patients diagnosed with acute cerebral hemorrhage admitted to the Department of Neurology,Affiliated Hospital of Jiujiang University from February 2021 to October 2022 were collected.After excluding patients with incomplete information,we collected a total of 84 patient data and divided into groups according to plasma osmolality values: > 310 m Osm/L for high plasma osmolality group and 280-310 m Osm/L for normal plasma osmolality group.Baseline hematoma and edema volumes were obtained by CT scan,residual edema and hematoma volumes were dynamically monitored at 7 days,NIHSS scores at 1 and 7days were monitored to assess neurological dysfunction,and 90-day follow-up and m RS Scores were performed.All data were statistically analyzed using SPSS21.0.Results:1、Clinical data of patients: A total of 84 patients were included in this study,of which 28(33.3%)were women and 56(66.7%)were men.The average age of these patients was 64.88±13.46 years old,57(67.9%)patients with hypertension,12(14.3%)diabetes patients,Five(6.0%)patients with heart disease,27(32.1%)patients with hyperlipidemia,8(9.5%)patients with a history of antiplatelet aggregation drugs,2(2.4%)patients with a history of anticoagulants,17(20.2%)patients with a history of smoking,and patients with a history of drinking In 14(16.7%)cases,the 3-month m Rs score was 2.27±1.78.In treatment,75(89.3%)of patients used dehydration drug.Among the 84 patients,we estimated the changes in plasma osmotic pressure,hematoma volume,edema around hematoma,and NIHSS score.You can see that the plasma osmotic pressure from day 1 300.56±6.34 m Oms/L to day 7 30.04±13.48 m Oms/L,NIHSS score from day 1 13.36±8.94 to day 710.98±8.30,hematoma volume from day 1 2 0.97±19.1m L to 16.57±14.89 m L on the7 th day,and the volume of edema around the hematoma from 16.10±15.45 m L on the first day to 30.04±25.15 m L on the 7th day,these changes are statistically significant.The median time from ICH to CT scan in these patients is 1 day,and the hematoma is located in the anterior circulation area.2、Correlation analysis among all factors: In the correlation study,we can see that the plasma osmotic pressure on the 7th day affects the residual hematoma volume on the 7th day and the clinical outcome of the NIHSS score on the 7th day(0.006 and 0.045 respectively);the clinical results of the NIHSS score on the 7th day are highly affected by the following four factors: 1.Plasma osmotic pressure on the7 th day(P=0.045),2.Residual edema volume on the 7th day(P=0.004),3,hematoma volume on the 1st day(P<0.001),4.Residual hematoma volume on the 7th day(P<0.001);The 3-month m Rs score is influenced by the following 3 factors: 1.Baseline edema volume(P=0.034),2.Hematoma volume on the first day(P=0.001),3.Hematoma volume on the seventh day(P=0.0029),4.Edema volume on the seventh day(P=0.052).However,we found that none of the measurement parameters were related to baseline plasma osmotic pressure,and the volume of edema around the hematoma(whether on day 1 or day 7)was not related to the plasma osmotic pressure on days 1 and 7th days.All p-values and calculated Pearson correlations differ statistically without statistical significance.We also found that although the volume of edema around the hematoma does not depend on plasma osmotic pressure,the residual hematoma volume on the 7th day(P=0.006)and the NIHSS score on the 7th day(P=0.045)are correlated with the plasma osmotic pressure on the 7th day.3、Prognosis of patients with high plasma osmotic pressure and cerebral hemorrhage on day 7 : The baseline data of 20 patients with elevated plasma osmotic pressure on the 7th day and 64 patients with normal plasma osmotic pressure were compared.The two groups showed a balanced state in terms of baseline conditions such as gender,hypertension,diabetes,heart disease,antiplatelet aggregation drug treatment,anticoagulant drug treatment,smoking and drinking history.The difference was not statistically significant(P>0.05),which showed that the two groups were comparable.But we can see that there are statistical differences in age between the two groups.Clinical outcomes of the high plasma osmolality group on day 7 compared with the normal group: The plasma osmotic pressure on the7 th day was significantly different between the two groups(P<0.05);the 7-day hematoma volume of the high plasma osmotic pressure group and the normal group on the 7th day was 23.4±17.8m Lvs14.4±13.3m L,P=0.018,which is statistically significant;NIHSS on The score is also significantly different between the two groups(P=0.008).Single-factor analysis suggests that there is a certain trend between the increase of plasma osmotic pressure on the 7th day and the clinical outcome of the3 rd month.The higher the osmotic pressure,the worse the prognosis(P = 0.051).The study found that the increase of baseline plasma osmotic pressure has nothing to do with the three-month m Rs after ICH,whether in univariate or multivariate analysis.After adjusting for sex,age,hypertension,diabetes,baseline NIHSS,and high-and low-density lipoprotein,dichotomous logistic regression analysis showed an independent correlation between hematoma volume and adverse prognosis at the third month(OR=1.067;95% CI: 1.018-1.118;P=0.007).In contrast,there was no significant correlation between baseline plasma osmolality and day 7 plasma osmolality and poor prognosis.4、Comparison of the effect of normal and abnormal plasma osmolarity on brain edema absorption on the 7th day: In order to investigate whether abnormal plasma osmotic pressure affects the absorption of cerebral edema after cerebral hemorrhage,we included 84 ICH patients,including 20 patients with high plasma osmotic pressure and 64 patients with normal plasma osmotic pressure.We compared the volume of cerebral edema in the two groups 7 days after cerebral hemorrhage.The results showed that the average PHE volume of the high plasma osmotic pressure group was 35.2±28.2m L,the normal group was 28.3±24.2m L respectively,and P>0.05 had no statistical significance.Tables 6,7 and 8 multiple linear regressions show that plasma osmotic pressure on the 7th day has nothing to do with the hematoma volume,edema volume and NIHSS score on the 7th day.Conclusion:The higher the plasma osmolality on day 7,the higher the NIHSS score and the larger the hematoma;The higher the plasma osmolality on day 7,the worse the clinical outcome at month 3 is likely to be;Elevated plasma osmolality may not affect the development of edema around the hematoma after intracerebral hemorrhage. |
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