高血压性脑出血严重并发症临床分析

Clinic analysis of severe complication of hypertensive cerebral hemorrhage

目的 分析高血压性脑出血严重并发症与治疗间的关系 ,探讨其产生机理 ,提高生存率 ,降低致残及死亡率。 方法 回顾性分析住院治疗的 1 4 0例高血压性脑出血患者 (其中含高血压性蛛网膜下腔出血 6例 )临床出现的严重并发症、出血部位、出血量与治疗间的关系。 结果 1 4 0例中死亡 4 6例 ,存活者 90例。 (1 )出血部位 :1 4 0例中右脑半球 73例 ,左脑半球 5 6例 ,脑干 4例 ,脑室 1例。 (2 )并发症 :死亡组与生存组并发肺部感染分别为 1 7例、1 2例 ;肾功能不全 2 0例、2 7例 ;消化道出血 9例、8例 ;尿路感染 1 7例、2 6例 ;急性心肌梗死 3例、1例 ;呼吸衰竭2 1例、3例 ;电介质紊乱 1 3例、3 2例 ;高血糖症 2 2例、4 0例 ;症状性癫痫 4例、3例 ;脑疝 4例、1例 ;代谢性酸中毒 4例、2例 ;代谢性碱中毒各 6例。 (3 )心脏节律与缺血变化 :高血压性脑出血组与非高血压性脑出血组中窦性心动过速发生率分别为 2 7例、4例 ;窦性心动过缓 1 9例、2例 ;左前半束枝阻滞 1 2例、0例 ;右束枝阻滞 7例、0例 ;I0 A VB 5例、0例 ;房性早搏 1 1例、1例 ;室性早搏 6例、0例 ;阵发性房速 2例、1例 ;快速房颤 2例、0例 ;游走节律 2例、0例 ;A V脱节 1例、0例 ;P波变化 1 0例、0例 ;Q T间期延长 4 8例、3例 ;

Objective To analyse the relations of severe complication of hypertensive cerebral hemorrhage and treatment,explore mechanism of production,improve survival rate,and decrease the mained rate and fatality Methods The clinical data of 140 patients with hypertensive cerebral hemorrhage(1999 1～2002 12) were retrospectively analyed on the relationship of the severe complication,common hemorrhagenic region,amount of bleeding and treatment to the severity of the disease Results After treatment 46 cases died and 94 cases survived:①hemorrhagenic region:Among the 140 cases hemorrhage of right side cerebral hemisphaerium was 73 cases,left side cerebral hemisphaerium was 56 cases,brain stem was 4 cases and only 1 case was ventricle of brain ②complication:In death group and survival group the infection of lung was 17 cases and 12 cases,renal insufficiency 20 cases and 27 cases,hemorrhage of gastrointestinal tract 9 cases and 8 cases,urinary tract infection 17 cases and 26 cases,acute myocardial infarction 3 cases and 1 case,respiratory failure 21 cases and 3 cases,electrolyte disorder 13 cases and 32 cases,hyperglycemia 22 cases and 44 cases,symptomatic epilepsy 4 cases and 3 cases,cerebral hernia 4 cases and 1 case,metabolic acidosis 4 cases and 2 cases,metabolic alkalosis both 6 cases ③The cardiac change of rhythm and is chemia:In hemorrhage group and non hemorrhage group sinus tachycardia was 27 and 4 cases,sinus bradycardia 19 cases and 2 cases,atrial premature beat 11 cases and 1 case paroxysmal auricular tachycardia 2 cases and 1 case,left anterior hemibandle branch block 12 cases and right bundle branch block 7 cases I 0A VB(first degree A V block) 5 cases ventricular prematus beat 6 cases,Q T interval prolongation 48 cases and 3 cases,ischemic type S T segment depression 64 cases and 6 cases,ischemic type T U wave change 67 cases and 5 cases rapid atrial fibrillation(AF) 2 cases,A V dissociation 1 case,wandering heart rhythm 2 cases,P wave change 10 cases only in hemorrhage group Conclusion Hypertension is the principal risk factor of cerebral hemorrhage The occurrance of hypertensive cerebral hemorrhage not only was high but also the complications,such as multiple system organs damage much more common,so the mortality was high For this season,large scale prevention and treatment must be carried out to combat hypertension in order to decsease death the patients with hypertensive cerebral hemorrhage and their complication should be treated in time