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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Effect of Hyperosmolar Therapy on Outcome Following Spontaneous Intracerebral Hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study
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Effect of Hyperosmolar Therapy on Outcome Following Spontaneous Intracerebral Hemorrhage: Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) Study

机译：高渗疗法对自发脑出血后结果的影响：脑出血（ERICH）研究的种族/种族变化

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Purpose: We aimed to identify the effect of hyperosmolar therapy (mannitol and hypertonic saline) on outcomes after intracerebral hemorrhage (ICH) in the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study. Methods: Comparison of ICH cases treated with hyperosmolar therapy versus untreated cases was performed using a propensity score based on age, initial Glasgow Coma Scale, location of ICH (lobar, deep, brainstem, and cerebellar), logtransformed initial ICH volume, presence of intraventricular hemorrhage, and surgical interventions. ERICH subjects with a pre-ICH modified Rankin Scale (mRS) score of 3 or lower were included. Treated cases were matched 1: 1 to untreated cases by the closest propensity score (difference = 15), gender, and race and ethnicity (non-Hispanic white, non-Hispanic black, or Hispanic). The McNemar and the Wilcoxon signed-rank tests were used to compare 3-month mRS outcomes between the 2 groups. Good outcome was defined as a 3-month mRS score of 3 or lower. Results: As of December 31, 2013, the ERICH study enrolled 2279 cases, of which 304 hyperosmolar-treated cases were matched to 304 untreated cases. Treated cases had worse outcome at 3 months compared with untreated cases (McNemar, P = .0326), and the mean 3-month mRS score was lower in the untreated group (Wilcoxon, P = .0174). Post hoc analysis revealed more brain edema, herniation, and death at discharge for treated cases. Conclusions: Hyperosmolar therapy was not associated with better 3-month mRS outcomes for ICH cases in the ERICH study. This finding likely resulted from greater hyperosmolar therapy use in patients with edema and herniation rather than those agents leading to worse outcomes. Further studies should be performed to determine if hyperosmolar agents are effective in preventing poor outcomes.
机译：目的：在脑出血种族/种族差异（ERICH）研究中，我们旨在确定高渗治疗（甘露醇和高渗盐水）对脑出血（ICH）后预后的影响。方法：采用基于年龄、初始格拉斯哥昏迷评分、ICH位置（脑叶、深部、脑干和小脑）、初始ICH体积、脑室内出血和手术干预的倾向评分，对接受高渗治疗的ICH患者与未经治疗的ICH患者进行比较。包括ICH前改良Rankin量表（mRS）评分为3分或更低的ERICH受试者。根据最近的倾向评分（差异；=15）、性别、种族和民族（非西班牙裔白人、非西班牙裔黑人或西班牙裔），治疗病例与未治疗病例的比例为1:1。McNemar和Wilcoxon符号秩检验用于比较两组之间3个月的mRS结果。良好结果定义为3个月内mRS评分为3分或更低。结果：截至2013年12月31日，ERICH研究纳入了2279例患者，其中304例高渗治疗病例与304例未治疗病例相匹配。与未经治疗的病例相比，经治疗的病例在3个月时的预后更差（McNemar，P=0.0326），未经治疗组的平均3个月mRS评分更低（Wilcoxon，P=0.0174）。事后分析显示，接受治疗的患者在出院时出现更多脑水肿、脑疝和死亡。结论：在ERICH研究中，对于ICH患者，高渗治疗与更好的3个月mRS结果无关。这一发现可能是因为水肿和疝气患者使用高渗治疗，而不是那些导致更糟糕结果的药物。应进行进一步研究，以确定高渗剂是否能有效预防不良结局。

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