第四脑室出血扩张与预后关系的探讨

The relationship between hemorrhagic dilation of the fourth ventricle and outcome

作者报道１９８８～１９９５年经ＣＴ扫描证实的成人第四脑室出血（ＩＶＨ）５２例临床治疗资料。其中２８例有第四脑室出血并第四脑室扩张，尽管采取积极的综合治疗，所有患者均死亡。另２４例第四脑室出血非扩张者，有１０例死亡，１４例生存，质量良好。第四脑室出血扩张患者的死亡率明显高于非扩张组患者。两组ＧＣＳ评分存在较大差异。多因素分析提示，第四脑室出血扩张是预测预后的一项最有意义的指标，其次是ＧＣＳ评分，居第三位的是弥漫性脑室出血。

adult patients with CT documented fourth intraventricular hemorrhage(FIVH) were treated.The various etiologic findings included intraparenchymal hemorrhage with secondary FIVH(24 cases), spontaneous subarachnoid hemorrhage(8), spontaneous IVH(12), and trauma (8). Of the 52 patients, 28 died because of hemorrhagic dilation of the fourth ventricle in spite of aggressive therapy.Of the 24 FIVH patients without dilation, 10 died and 14 survived. The survival rate for the patients with hemorrhagic dilation of the fourth ventricle was significantly lower than that for FIVH patients without dilation. Of the 28 patients with FIVH associated with dilation,24 presented with a Glasgow Coma Scale(GCS) score of less than 5 or 5, 2 with a GCS score of 7, and 2 with a GCS score of 13. In the 24 FIVH patients without dilation,8 presented with a GCS score of 3 to 5 (seven died and one survived), 4 with a GCS score of 6 to 8 (two died and two had survival) , 5 with a GCS score of 9 to 12 (one died and four had survival),and 7 with a GCS score of 13 to 15. There was a great difference of GCS scores between the two groups. Logistic regression multivariate analysis demonstrated that hemorrhagic dilation of the fourth ventricle was the most significant outcome predictor, followed by GCS score and then the presence of diffuse IVH.