Kiểm soát huyết áp và kết quả lâm sàng trong điều trị chảy máu não cấp tính=Control of blood pressure and clinical outcomes in acute intracerebral hemorrhage treatment

0 Người đánh giá. Xếp hạng trung bình 0

Tác giả: Nguyễn Nhựt Tín Lê, Anh Tài Nguyễn

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Y học Việt Nam (Tổng hội Y học Việt Nam), 2024

Mô tả vật lý: tr.62-68

Bộ sưu tập: Metadata

ID: 242223

Thêm vào giỏ

Đánh giá mối liên hệ giữa huyết áp tâm thu (HATT) lúc nhập viện, các mức HATT duy trì trong 24 giờ đầu nhập viện, và kết quả tình trạng chức năng được đánh giá bằng thang đo Rankin sửa đổi 60 ngày sau xuất viện. Đối tượng và phương pháp: Phân tích dữ liệu bệnh nhân (BN) chảy máu não (CMN) tự phát được chăm sóc tại Khoa Nội thần kinh Bệnh viện Chợ Rẫy trong giai đoạn từ tháng 10 đến tháng 12 năm 2023 các BN tuổi ≥ 18 được chẩn đoán bị CMN tự phát, có HATT cao lúc nhập viện (HATT ≥ 150 mmHg). BN được loại trừ nếu (1) có nguyên nhân do tổn thương cấu trúc, (2) điểm hôn mê Glasgow (GCS) lúc nhập khoa thấp (3-5 điểm). Các biến số về HATT được đánh giá dưới dạng các biến liên tục và là biến cơ sở để phân tích. Kết quả: 563 BN được chẩn đoán CMN được điều trị nội trú, có 74 BN được đưa vào nghiên cứu. Tuổi trung bình 54 ± 11
Nữ: 19/74 (25,7%), nam giới: 55/74 (74,3%). Thời gian trung bình kể từ khi xuất hiện các triệu chứng đến nhập viện là 19 giờ (2- 90 giờ). Độ nặng CMN trung bình theo thang điểm chảy máu não (ICH): 1,27 điểm (0-4). HATT trung bình khi nhập viện: 169 mmHg (150-230), các mức HATT duy trì trong 24 giờ đầu gồm: <
120 mmHg: 5/74 (6,8%), 120-139 mmHg: 34 (45,9%) và 140-159 mmHg: 35/74 (47,3%). Những BN có mức HATT duy trì trong 24 giờ đầu 120-139 mmHg khuynh hướng có kết quả chức năng xấu hơn vào thời điểm 60 ngày sau ra viện. Kết luận: Mức HATT duy trì trong 24 giờ đầu sau nhập viện có thể tiên lượng tình trạng chức năng sau ra viện (HATT trong khoảng 120- 139 mmHg có diện tích dưới đường cong ROC >
0,7, tuy nhiên chưa đủ độ mạnh thống kê (p=0,07). Kích thước ổ máu tụ >
14,35ml (độ nhạy 77%, độ đặc hiệu 78%)
>
16,5ml (độ nhạy 64%, độ đặc hiệu 73%) có tiên lượng kết quả chức năng xấu sau 60 ngày.The relationship between systolic BP at admission, systolic BP levels maintained during the first 24 hours of admission, and functional status outcomes was assessed using the revised Rankin Scale at 60 days after discharge. Methods: We performed data analysis of patients intracerebral haemorrhage (ICH) cared for in the Department of Neurology of Cho Ray Hospital for the period from October to December 2023. The study included adult patients (aged ≥ 18) who were diagnosed with spontaneous ICH and had high systolic BP at admission (systolic BP ≥ 150 mmHg). Patients were excluded if (1) there is a cause of structural damage, (2) the Glasgow coma score (GCS) at admission to the Department of Neurology is low (3-5 points). Variables in systolic blood pressure are evaluated as continuous variables and are the baseline variable for analysis. Therefore, we analyzed only patients who had sufficient data on systolic blood pressure. Results: There were 563 patients diagnosed ICH who were cared for at the Department of Neurology at Cho Ray Hospital during this period, however after applying the study participation criteria, only 74 patients were included. The group had an average age of 54 ± 11, with 19 female patients (25.7%) and males 55 (74.3%). The median time from onset of ICH symptoms to hospitalization is 19 hours (2–90 hours). The ICH severity is 1.27 points (0–4) as determined by the ICH scale. The mean systolic blood pressure at admission was 169 mmHg (150-230), systolic blood pressure levels maintained during the first 24 hours: <
120 mmHg: 6.8% (5 patients), 120-139 mmHg: 45.9% (34 patients), and 140-159 mmHg: 47.3% (35 patients). Patients with systolic BP levels maintained in the first 24 hours of 120-139 mmHg tended to have worse functional outcomes 60 days after discharge Conclusion: Systolic BP levels maintained in the first 24 hours after admission can predict post-discharge functional status (systolic BP between 120-139 mmHg has an area below the ROC curve of >
0.7, but is not statistically strong enough (p=0.07). Hemorrhagic size above 14.35 ml (sensitivity 77%, specialization 78%) and over 16.5 ml (sensitivity 64%, specialization 73%) prognosis of poor functional outcomes at 60 days.

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