Các yếu tố tiên lượng của bệnh nhân chảy máu não cấp vùng trên lều do tăng huyết áp

Acute supratentorial cerebral hemorrhage (ASICH) due to hypertension represents a significant neurological emergency, contributing to a substantial proportion of non-traumatic intracranial hemorrhages. This condition carries a high mortality rate, ranging from 10% to 30% of all strokes, with 30-day mortality reaching 40-50%. Given its severe prognosis and devastating impact on patients' lives, early identification of prognostic factors is crucial for effective patient management and improving outcomes. This study aims to evaluate and identify key prognostic factors in patients suffering from acute supratentorial cerebral hemorrhage attributed to hypertension, thereby informing clinical strategies to mitigate adverse outcomes.

Neurologists, neurosurgeons, emergency physicians, internal medicine specialists, medical researchers, and postgraduate students interested in cerebrovascular diseases and acute stroke management.

This study conducted a cross-sectional, prospective descriptive analysis of 150 patients diagnosed with acute supratentorial cerebral hemorrhage (ASICH) secondary to hypertension. Patients were admitted for inpatient treatment at the Neurology Center, Bach Mai Hospital, between August 1, 2023, and July 31, 2024. The primary objective was to identify the prognostic factors influencing outcomes after three months, assessed using the modified Rankin score (mRS). The findings revealed that 73.3% of patients had a good outcome (mRS 0-3). However, several significant prognostic factors for poor outcomes (mRS 4-6) were identified. These included age greater than 60 years (34.6% poor outcome rate compared to 18.1% for those 60 or younger, p<0.05), hematoma volume of 30 ml or more (100% poor outcome rate compared to 14.1% for less than 30 ml, p<0.01), a Glasgow Coma Scale score below 14 at admission (71.9% poor outcome rate compared to 14.4% for scores ≥ 14, p<0.01), and the presence of intraventricular hemorrhage (36.9% poor outcome rate compared to 18.8% for those without, p<0.05). Conversely, factors such as a history of hypertension, diabetes, coronary artery disease, antiplatelet drug use, smoking, and alcohol consumption did not show a statistically significant correlation with outcomes at 90 days. These results emphasize the critical role of age, hematoma size, initial neurological status, and intraventricular involvement as key prognostic factors in managing patients with acute supratentorial intracerebral hemorrhage due to hypertension. The identification of these factors can aid clinicians in early risk stratification, guiding intensive care decisions, and potentially improving therapeutic interventions and patient outcomes.