| 摘要: |
| ［摘要］ 目的 分析脑出血（ICH）合并肺栓塞（PE）患者发生不良功能结局的危险因素，为早期识别高危人群及改善患者预后提供参考。方法 回顾性分析2013年1月至2024年12月广西医科大学第一附属医院收治的152例成年急性自发性ICH合并PE患者的临床资料。根据出院时改良Rankin量表（mRS）评分将患者分为良好功能结局组（mRS评分0～2分，43例）和不良功能结局组（mRS评分3～6分，109例）。采用多因素logistic回归分析ICH合并PE患者不良功能结局的影响因素。结果 152例患者住院期间病死率为9.21%，109例（71.71%）出院时存在不良功能结局。与良好功能结局组比较，不良功能结局组中高血压、偏瘫、昏迷、脑室内出血（IVH）、脑室外引流术及抗凝治疗比例较高，卧床时间较长，全身炎症反应指数（SIRI）、确诊PE时D-二聚体、D-二聚体动态变化值1（ΔD-二聚体1=确诊PE时D-二聚体水平-入院时D-二聚体水平）及全身免疫炎症指数（SII）水平较高，去骨瓣减压术比例较低，活化部分凝血活酶时间（APTT）较短，平均红细胞血红蛋白浓度（MCHC）较低，差异有统计学意义（P<0.05）。多因素logistic回归分析结果显示，IVH及较高的ΔD-二聚体1、SIRI水平是ICH合并PE患者发生不良功能结局的危险因素（P<0.05）。结论 IVH及较高的ΔD-二聚体1、SIRI水平是ICH合并PE患者发生不良功能结局的独立危险因素。 |
| 关键词: 脑出血 肺栓塞 功能结局 脑室内出血 D-二聚体 全身炎症反应指数 危险因素 |
| DOI：10.3969/j.issn.1674-3806.2026.07.06 |
| 分类号:R 743.3 |
| 基金项目:国家自然科学基金项目（编号：82260243）；广西重点研发计划项目（编号：桂科FN2600640018） |
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| Analysis of risk factors of adverse functional outcomes in intracerebral hemorrhage patients complicated with pulmonary embolism |
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Xu Lishan, Wei Hong, Wang Miao, Huang Xiulin, Liang Zhijian
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Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To analyze the risk factors of adverse functional outcomes in intracerebral hemorrhage(ICH) patients complicated with pulmonary embolism(PE), aiming to facilitate early identification of high-risk individuals and improve the patients′ prognosis. Methods A retrospective analysis was conducted on the clinical data of 152 adult patients with acute spontaneous ICH complicated with PE who were admitted to the First Affiliated Hospital of Guangxi Medical University from January 2013 to December 2024. According to the modified Rankin Scale(mRS) scores at discharge, the patients were divided into a good functional outcome group(mRS scores of 0-2 points, n=43) and an adverse functional outcome group(mRS scores of 3-6 points, n=109). Multivariate logistic regression was used to analyze the influencing factors of adverse functional outcomes in the ICH patients complicated with PE. Results Among the 152 patients, the in-hospital mortality rate was 9.21%, and 109 patients(71.71%) had adverse functional outcomes at discharge. Compared with the good functional outcome group, the adverse functional outcome group had higher proportions of patients with hypertension, hemiplegia, coma, intraventricular hemorrhage(IVH), external ventricular drainage and anticoagulation therapy, and had longer time spent bedridden, higher levels of systemic inflammatory response index(SIRI), D-dimer when diagnosed with PE, dynamic changing value 1 of D-dimer(ΔD-dimer1=D-dimer level when diagnosed with PE-D-dimer level at admission) and systemic immune-inflammation index(SII), and a lower proportion of patients receiving decompressive craniectomy, shorter activated partial thromboplastin time(APTT), lower mean corpuscular hemoglobin concentration(MCHC), with statistically significant differences(P<0.05). The results of multivariate logistic regression analysis showed that IVH, higher ΔD-dimer1 and SIRI levels were risk factors of adverse functional outcomes in ICH patients complicated with PE(P<0.05). Conclusion IVH, higher ΔD-dimer1 and SIRI levels are independent risk factors of adverse functional outcomes in ICH patients complicated with PE. |
| Key words: intracerebral hemorrhage(ICH) pulmonary embolism(PE) functional outcome intraventricular hemorrhage(IVH) D-dimer systemic inflammatory response index(SIRI) risk factors |
