Analysis On Correlation Factors Of Hematoma Enlargement In Acute Stage After Hypertensive Cerebral Hemorrhage

ObjectiveTo analysis the relative factors of hematoma enlargement in acute stage after hypertensive cerebral hemorrhage.Methods1.To review the clinical data of the168patients with HICH in the Shangqiu First People’s Hospital from March2009to March2013.2.These cases were analyzed retrospectively. The first or the second cerebral CT examinations were finished in first six hours after bleeding occurred. The patients were carriered on the second、the third or the forth cerebral CT examination in24-72hours.3.The hemorrhage quantity is calculated by Dotian formula according to the head CT. According to the CT results, the bleeding site, hematoma shape and bleeding volume would be determinated. The blood pressure results of patients and mannitol use situation in early time were monitored for statistic.4.49cases appeared hematoma enlargement, and the incidence rate was29.17%.119cases didn’t appeared hematoma enlargement, and the incidence rate was70.83%.5.This research contrastively analysized the relationship of early hematoma enlargement about the basic situations, the attack time, the patients’blood pressure level, the bleeding site, the hematoma shape, the mixed density and high doses of mannitol use in ultra-early stage (<6hours)Results (1) There was no significant difference between the hematoma enlargement groups and the non-enlargement groups about the basic situations.(2) In the hematoma enlargement cases, about78.26%of hematoma enlargement occurred in the first6hours after cerebral hemorrhage,30.43%within6hours to24hours,and13.04%within24hours to72hours.(3) The higher systolic blood pressure(SBP) at admission and after admission were correlative with hematoma enlargement within6h. The patients who kept higher SBP got higher incidence rate. And the single factor indicated that the difference was statistically significant.(4) The hematoma of hypertensive cerebral in basal ganglia breaking into the ventricle is easier expansion than the one no breaking(χ2=8.8939, P=0.0029); The early hematoma enlargement’s incidence rate and the different bleeding site of non-breaking patients had no significant difference(χ2=0.4232, P>0.05); In basal ganglia breaking into ventricle situation, hematoma enlargement in thalamus and inner basal ganglia got higher occurrence than other bleeding site, so there had significant difference(P<0.05).(5) The hematoma of hypertensive cerebral being irregular-shaped is apparently easier expansion than the one being regular-shaped.(6) According to the cerebral CT results, the patients which occurred high density or mixed density in hematoma had higher enlargement rate than non-mixed density situation(χ2=15.61P<0.005).(7) The influence of using mannitol after the onset on ultra early enlargement of hematoma was analyzed. The patients which used large dose mannitol in ultra early stage were easier occurred enlargement than the patients without using large dose mannitol. There had significant difference between them(χ2=4.235, P=0.04); Using large dose mannitol in ultra early stage maybe is one of factors which leading hematoma enlargement.Conclusions (1) The hematoma enlargement was the most prone to occur in the first6hours (ultra-early stage) after cerebral hemorrhage. (2) After admission6h, patients which keeping higher SBP and higher diastolic blood pressure (DBP) were easy to occur hematoma enlargement.(3) The hematoma of hypertensive cerebral in basal ganglia breaking into the ventricle is easier expansion than the one no breaking in acute stage. In basal ganglia breaking into ventricle situation, hematoma enlargement in thalamus and inner basal ganglia got higher occurrence than other bleeding site.(4) The hematoma of hypertensive cerebral being irregular-shaped is apparently easier expansion than the one being regular-shaped.(5) According to the cerebral CT results, the patients which occurred mixed density in hematoma had higher enlargement rate than non-mixed density situation.(6) Using large dose mannitol in ultra early stage was easy to occur hematoma enlargement.