脑溢血的高危因素??糖尿病，高血压

高血压和糖尿病??自发性脑内出血后早期死亡的预示指标。

Tetri S对379例自发性脑内出血的病例进行分析后发现，3个月之内的死亡率为28%。

作者发现在3个月之内死亡的病人在入院时有很高的血糖水平和平均动脉压。上海东方医院神经外科魏社鹏

在充分考虑了病人的性别年龄血肿位置和大小，GCS评分，脑室内出血，心脏病，华法令使用等因素之后，糖尿病和高的平均动脉压成为两个独立的预示指标。

入院时较高的血糖水平和高血压病史病不是早期死亡的预示因素。

结论：高的平均动脉压被发现时自发性脑内出血早期死亡的一个独立的因素。高血压病史和早期死亡并无关联。入院时的高血糖水平和出血的严重程度相关，但和早期死亡无关。糖尿病病史也是个早期死亡的预示指标。

J Neurosurg. 2009 Mar;110(3):411-7. Hypertension and diabetes as predictors of early death after spontaneous intracerebral hemorrhage. Tetri S, Juvela S, Saloheimo P, Pyhtinen J, Hillbom M. 1 Departments of Neurosurgery,, 2 Neurology, and, 3 Radiology, Oulu University Hospital, Finland; and, 4 Departments of Neurosurgery, Helsinki and Turku University Hospitals, Finland. Object Previous investigators have suggested that a high mean arterial blood pressure (MABP) and an elevated plasma glucose level at admission are associated with a poor outcome after hemorrhagic stroke. It remains unclear, however, whether hypertension and diabetes are responsible for this effect. High admission MABP and plasma glucose levels may also be markers of other factors such as stroke severity. Methods The authors retrospectively investigated the role of a high admission MABP and plasma glucose level together with other predictors of early death among 379 nonsurgical patients with spontaneous intracerebral hemorrhages (ICHs) who were admitted to the stroke unit of Oulu University Hospital. Results The 3-month mortality rate was 28%. The patients who died within 3 months of ICH had significantly higher plasma glucose levels and MABPs at admission (p < 0.001). After adjustments for patient sex, age, size and location of hematoma, Glasgow Coma Scale score at admission, presence of intraventricular hemorrhage, history of cardiac disease, and previous use of warfarin, history of diabetes (relative risk 1.61, 95% CI 1.03-2.53, p < 0.05) and high MABP at admission (relative risk 1.01 per mm Hg, 95% CI 1.00-1.02, p < 0.05) remained independent predictors of death 3 months after ICH. A high admission plasma glucose level and history of hypertension were not independent predictors of death. Conclusions A high MABP at admission was found to be an independent predictor of early death in patients with ICH. History of hypertension was not responsible for the effect. Admission hyperglycemia appeared to be a stress response to the severity of the bleeding, whereas diabetes predicted early death.