高血压性脑出血70例术后死亡原因分析

Analysis of death caused by hypertensive cerebral hemorrhage post operation in 70 cases

目的总结高血压脑出血(HCH)术后死亡的原因,探讨手术指征,选择合适的手术病例,降低死亡率。方法对70例HCH手术后死亡患者的临床资料进行回顾性分析,找出与死亡相关的主要因素。结果术前脑疝形成使中枢衰竭在1周内死亡者43例,其中双侧瞳孔散大30例,单侧瞳孔散大13例;各种并发症在2～3周内死亡者27例:肺部感染11例,上消化道出血6例,急性肾功能衰竭5例,多脏器功能衰竭3例,心功能衰竭1例,体液代谢紊乱1例。结论脑出血后脑疝形成及术后多脏器并发症是术后死亡的主要原因。脑血肿残腔再出血,恶性脑肿胀,营养衰竭是术后死亡的危险因素。及时手术减少术前脑疝形成,术后严格监测生命体征,稳定血压,早期对并发症预防性治疗及合理的营养支持是降低死亡率的关键。

Objective To explore the indication of operation and choose suitable case through analysis of cause of hypertensive cerebral hemorrhage （HCH） post operation, in order to reduce the rate of death. Methods Clinical data of 70 death cases hypertensive cerebral hemorrhage after operation was analyzed retrospectively, then find out the primary reason relative to death based on the analysis. Results Forty three cases were died from cerebral hernia before operation 1 week, in which 30 cases with bilateralis mydriasis, and the other 13 cases with half mydriasis. Twenty seven cases died from various complication during 2 - 3 weeks, in which 11 cases with pulmonary infection, 6 cases with upper gastrointestinal hemorrhage （UGIH）, 5 cases with acute renal failure （ARF）, 3 cases with multiple organ failure, 1 case with heart failure, 1 case with metabolic disorder of body fluid. Conclusions Formation of cerebral hernia after cerebral hemorrhage and complication of multiple organs after operation are primary reasons of the death after operation. Rehemorrhage of cephalophyma residue cavea and malignant swelling of cerebrum, nutrition failure are risk factors for the death after operation. Therefore, operation therapy can decrease the formation of cerebral hernia before operation in time, monitoring on vital sign and stabilization of blood pressure after operation, earlier prophylactic therapy on complication and reasonable nutritional support are key elements to cut down the rate of death.