DOI QR코드

DOI QR Code

Risk Factors of Rehemorrhage in Postoperative Patients with Spontaneous Intracerebral Hemorrhage : A Case-Control Study

  • Ren, Yanming (Department of Neurosurgery, West China Hospital, Sichuan University) ;
  • Zheng, Jun (Department of Neurosurgery, West China Hospital, Sichuan University) ;
  • Liu, Xiaowei (Department of Neurosurgery, West China Hospital, Sichuan University) ;
  • Li, Hao (Department of Neurosurgery, West China Hospital, Sichuan University) ;
  • You, Chao (Department of Neurosurgery, West China Hospital, Sichuan University)
  • 투고 : 2017.06.26
  • 심사 : 2017.09.05
  • 발행 : 2018.01.01

초록

Objective : Rehemorrhage is the most severe complication of postoperative patients with spontaneous intracerebral hemorrhage. The aim of the present study was to assess independent predictors of rehemorrhage and find the possibility of preventing rehemorrhage in postoperative patients with spontaneous intracerebral hemorrhage (sICH). Methods : Medical records of 263 postoperative patients with sICH from our Hospital were reviewed. The relationships between rehemorrhage and parameters were examined by univariate and multivariate analyses. The parameters include time from onset to surgery, hematologic paremeters, neuroimaging characteristics, level and variability of systolic blood pressure, medical histories, operation duration, and blood loss. In addition, relationship between rehemorrhage and clinical outcome were analyzed by using multivariate analyses. Results : Thirty-five (13.31%) patients experienced rehemorrhage after operation. Multivariate analyses indicated that the following factors were independently associated with rehemorrhage : history of diabetes mellitus (odds ratio [OR], 2.717; 95% confidence interval [CI], 1.005-7.346; p=0.049), and midline shift (for every 1 mm increase, OR, 1.117; 95% CI, 1.029-1.214; p=0.009). Rehemorrhage was an independent risk factor of poor functional outcome (OR, 3.334; 95% CI, 1.094-10.155; p=0.034). Conclusion : Our finding revealed that history of diabetes mellitus and admission midline shift were possibly associated with rehemorrhage in postoperative patients with sICH.

키워드

참고문헌

  1. Antihypertensive Treatment of Acute Cerebral Hemorrhage (ATACH) investigators : Antihypertensive treatment of acute cerebral hemorrhage. Crit Care Med 38 : 637-648, 2010 https://doi.org/10.1097/CCM.0b013e3181b9e1a5
  2. Anderson CS, Heeley E, Huang Y, Wang J, Stapf C, Delcourt C, et al. : Rapid blood-pressure lowering in patients with acute intracerebral hemorrhage. N Engl J Med 368 : 2355-2365, 2013 https://doi.org/10.1056/NEJMoa1214609
  3. Anderson CS, Huang Y, Wang JG, Arima H, Neal B, Peng B, et al. : Intensive blood pressure reduction in acute cerebral haemorrhage trial (INTERACT): a randomised pilot trial. Lancet Neurol 7 : 391-399, 2008 https://doi.org/10.1016/S1474-4422(08)70069-3
  4. Broderick JP, Brott T, Tomsick T, Miller R, Huster G : Intracerebral hemorrhage more than twice as common as subarachnoid hemorrhage. J Neurosurg 78 : 188-191, 1993 https://doi.org/10.3171/jns.1993.78.2.0188
  5. Cho DY, Chen CC, Chang CS, Lee WY, Tso M : Endoscopic surgery for spontaneous basal ganglia hemorrhage: comparing endoscopic surgery, stereotactic aspiration, and craniotomy in noncomatose patients. Surg Neurol 65 : 547-555; discussion 555-556, 2006
  6. Fujii Y, Takeuchi S, Sasaki O, Minakawa T, Tanaka R : Multivariate analysis of predictors of hematoma enlargement in spontaneous intracerebral hemorrhage. Stroke 29: 1160-1166, 1998 https://doi.org/10.1161/01.STR.29.6.1160
  7. Fujii Y, Tanaka R, Takeuchi S, Koike T, Minakawa T, Sasaki O : Hematoma enlargement in spontaneous intracerebral hemorrhage. J Neurosurg 80 : 51-57, 1994 https://doi.org/10.3171/jns.1994.80.1.0051
  8. Huhtakangas J, Lopponen P, Tetri S, Juvela S, Saloheimo P, Bode MK, et al. : Predictors for recurrent primary intracerebral hemorrhage: a retrospective population-based study. Stroke 44 : 585-590, 2013 https://doi.org/10.1161/STROKEAHA.112.671230
  9. Kiphuth IC, Huttner HB, Breuer L, Schwab S, Kohrmann M : Sonographic monitoring of midline shift predicts outcome after intracerebral hemorrhage. Cerebrovasc Dis 34 : 297-304, 2012 https://doi.org/10.1159/000343224
  10. Koch S, Romano JG, Forteza AM, Otero CM, Rabinstein AA : Rapid blood pressure reduction in acute intracerebral hemorrhage: feasibility and safety. Neurocrit Care 8 : 316-321, 2008 https://doi.org/10.1007/s12028-008-9085-8
  11. Kothari RU, Brott T, Broderick JP, Barsan WG, Sauerbeck LR, Zuccarello M, et al. : The ABCs of measuring intracerebral hemorrhage volumes. Stroke 27 : 1304-1305, 1996 https://doi.org/10.1161/01.STR.27.8.1304
  12. Kuwashiro T, Yasaka M, Itabashi R, Nakagaki H, Miyashita F, Naritomi H, et al. : Effect of prothrombin complex concentrate on hematoma enlargement and clinical outcome in patients with anticoagulant-associated intracerebral hemorrhage. Cerebrovasc Dis 31 : 170-176, 2011 https://doi.org/10.1159/000321766
  13. Lee HK, Ghani AR, Awang MS, Sayuthi S, Idris B, Abdullah JM : Role of high augmentation index in spontaneous intracerebral haemorrhage. Asian J Surg 33 : 42-50, 2010 https://doi.org/10.1016/S1015-9584(10)60008-5
  14. Manning L, Hirakawa Y, Arima H, Wang X, Chalmers J, Wang J, et al. : Blood pressure variability and outcome after acute intracerebral haemorrhage: a post-hoc analysis of INTERACT2, a randomised controlled trial. Lancet Neurol 13 : 364-373, 2014 https://doi.org/10.1016/S1474-4422(14)70018-3
  15. Massaro AR, Sacco RL, Mohr JP, Foulkes MA, Tatemichi TK, Price TR, et al. : Clinical discriminators of lobar and deep hemorrhages: the Stroke Data Bank. Neurology 41 : 1881-1885, 1991 https://doi.org/10.1212/WNL.41.12.1881
  16. Mayer SA, Rincon F : Treatment of intracerebral haemorrhage. Lancet Neurol 4 : 662-672, 2005 https://doi.org/10.1016/S1474-4422(05)70195-2
  17. Mendelow AD, Gregson BA, Fernandes HM, Murray GD, Teasdale GM, Hope DT, et al. : Early surgery versus initial conservative treatment in patients with spontaneous supratentorial intracerebral haematomas in the international surgical trial in intracerebral haemorrhage (STICH): a randomised trial. Lancet 365 : 387-397, 2005 https://doi.org/10.1016/S0140-6736(05)70233-6
  18. Mendelow AD, Gregson BA, Rowan EN, Murray GD, Gholkar A, Mitchell PM, et al. : Early surgery versus initial conservative treatment in patients with spontaneous supratentorial lobar intracerebral haematomas (STICH II): a randomised trial. Lancet 382 : 397-408, 2013 https://doi.org/10.1016/S0140-6736(13)60986-1
  19. Morgenstern LB, Demchuk AM, Kim DH, Frankowski RF, Grotta JC : Rebleeding leads to poor outcome in ultra-early craniotomy for intracerebral hemorrhage. Neurology 56 : 1294-1299, 2001 https://doi.org/10.1212/WNL.56.10.1294
  20. Morgenstern LB, Hemphill JC 3rd, Anderson C, Becker K, Broderick JP, Connolly ES Jr, et al. : Guidelines for the management of spontaneous intracerebral hemorrhage: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 41 : 2108-2129, 2010 https://doi.org/10.1161/STR.0b013e3181ec611b
  21. O'Donnell MJ, Xavier D, Liu L, Zhang H, Chin SL, Rao-Melacini P, et al. : Risk factors for ischaemic and intracerebral haemorrhagic stroke in 22 countries (the INTERSTROKE study): a case-control study. Lancet 376 : 112-123, 2010 https://doi.org/10.1016/S0140-6736(10)60834-3
  22. Ohwaki K, Yano E, Nagashima H, Hirata M, Nakagomi T, Tamura A : Blood pressure management in acute intracerebral hemorrhage: relationship between elevated blood pressure and hematoma enlargement. Stroke 35 : 1364-1367, 2004 https://doi.org/10.1161/01.STR.0000128795.38283.4b
  23. Pantazis G, Tsitsopoulos P, Mihas C, Katsiva V, Stavrianos V, Zymaris S : Early surgical treatment vs conservative management for spontaneous supratentorial intracerebral hematomas: a prospective randomized study. Surg Neurol 66 : 492-501; discussion 501-502, 2006 https://doi.org/10.1016/j.surneu.2006.05.054
  24. Qureshi AI, Tuhrim S, Broderick JP, Batjer HH, Hondo H, Hanley DF : Spontaneous intracerebral hemorrhage. NeEngl J Med 344 : 1450-1460, 2001 https://doi.org/10.1056/NEJM200105103441907
  25. Rodriguez-Luna D, Pineiro S, Rubiera M, Ribo M, Coscojuela P, Pagola J, et al. : Impact of blood pressure changes and course on hematoma growth in acute intracerebral hemorrhage. Eur J Neurol 20 : 1277-1283, 2013 https://doi.org/10.1111/ene.12180
  26. Schachinger H, Langewitz W, Schmieder RE, Ruddel H : Comparison of parameters for assessing blood pressure and heart rate variability from non-invasive twenty-four-hour blood pressure monitoring. J Hypertens Suppl 7 : S81-S84, 1989 https://doi.org/10.1097/00004872-198904002-00017
  27. Sun W, Pan W, Kranz PG, Hailey CE, Williamson RA, Sun W, et al. : Predictors of late neurological deterioration after spontaneous intracerebral hemorrhage. Neurocrit Care 19 : 299-305, 2013 https://doi.org/10.1007/s12028-013-9894-2
  28. Tanaka E, Koga M, Kobayashi J, Kario K, Kamiyama K, Furui E, et al. : Blood pressure variability on antihypertensive therapy in acute intracerebral hemorrhage: the stroke acute management with urgent risk-factor assessment and improvement-intracerebral hemorrhage study. Stroke 45 : 2275-2279, 2014 https://doi.org/10.1161/STROKEAHA.114.005420
  29. Tapia-Perez JH, Gehring S, Zilke R, Schneider T : Effect of increased glucose levels on short-term outcome in hypertensive spontaneous intracerebral hemorrhage. Clin Neurol Neurosurg 118 : 37-43, 2014 https://doi.org/10.1016/j.clineuro.2013.12.018
  30. van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ : Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol 9 : 167-176, 2010 https://doi.org/10.1016/S1474-4422(09)70340-0
  31. Willmot M, Leonardi-Bee J, Bath PM : High blood pressure in acute stroke and subsequent outcome: a systematic review. Hypertension 43 : 18-24, 2004 https://doi.org/10.1161/01.HYP.0000105052.65787.35
  32. Woerdeman J, van Duinkerken E, Wattjes MP, Barkhof F, Snoek FJ, Moll AC, et al. : Proliferative retinopathy in type 1 diabetes is associated with cerebral microbleeds, which is part of generalized microangiopathy. Diabetes Care 37 : 1165-1168, 2014 https://doi.org/10.2337/dc13-1586
  33. Zheng D, Pan H, Cui X, Meng F, Sun G, Wang B : Preliminary study on changes in coagulation function and component transfusion time in patients with massive hemorrhage. Transfus Apher Sci 44 : 15-19, 2011 https://doi.org/10.1016/j.transci.2010.12.003

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