蛛网膜下腔出血不同时段意识障碍与预后关系分析

Analysis on the relationship between different onset time of disturbance of consciousness and prognosis in subarachnoid hemorrhage

目的 为探索预测蛛网膜下腔出血(SAH)预后的简便而有意义的方法。方法 收集106例SAH病例资料,在住院期间内死亡或存活为预后标准,观察其脑脊液(CSF)颜色、不同时段意识障碍与预后的关系;同时观察CSF颜色与不同时段意识障碍之间的关系。结果 多红细胞性CSF组死亡率显著高于少红细胞性CSF组(P<0.001);即发短暂意识障碍组预后显著好于起病时无意识障碍组(P<0.05),其相应淡血性CSF的比率前者显著高于后者(P<0.05);持续意识障碍比迟发意识障碍组死亡率高,但两组之间无显著差异(P>0.05)。结论 CSF颜色是预测SAH预后最直接、最有意义的指标,浓血性者出血量大,预后差。与之相对应,起病时立即意识障碍,短时内清醒者出血量相对少,预后相对佳,无此表现者相对较差,一旦发生迟发意识障碍或起病后持续意识障碍者预后均很差。

Objective To find out a simple and significant approach in predicting the prognosis of subarachnoid hemorrhage(SAH) .Methods 106 cases of SAH were studied.The survivals in the hospital day were as the criteria of prognosis, studying the extent of hemorrhage by the observation of the colour of CSF and its relation to different onset time of conscious disturbance and prognosis. Results The mortality in patients with high blood content CSF was significantly higher than those with low blood content(P < 0.001) .The prognosis in patients with brief conscious disturbance immediately after the onset of hemorrhage was prominently better than those without conscious disturbance at onset( P < 0.05) and their rate of correoponding low blood content (SF in the former was significantly higher than those in the latter( P < 0.05) .The mortality in patients with persistent or delayed conscious disturbance was high,but no statistical difference between the two groups was found ( P > 0.05) .Conclusion The color of CSF inspected by naked eye is the most direct and significant index for predicting the prognosis of SAH, and CSF with high blood contents showed poor prognosis. On the contrary patients with conscious disturbance occur immediately after the onset of SAH or recover shortly after the ocurrence of conscious disturbance.