原发性与继发性脑室出血的比较研究

Comparison study on primary and secondary intraventricular hemorrhage

目的研究原发性脑室出血(PIVH)与继发性脑室出血(SIVH)的病因、临床表现和预后,比较其异同点。方法回顾性分析22例PIVH患者和94例SIVH患者的临床资料。结果PIVH组与SIVH组有高血压病史者分别为50%和78.7%,差异有显著意义(P<0.05);两组临床表现相似,但SIVH组局灶性定位征多见(P<0.05);PIVH组再出血患者多于SIVH组(P<0.05);SIVH组的死亡率、致残率显著高于PIVH组,好转率低于PIVH组(P<0.05);两组中graeb分级的不同级别之间的好转率及死亡率有显著差异(P<0.05);两组再出血后死亡率升高,但无统计学差异(P>0.05)。结论PIVH与SIVH的主要病因是高血压;SIVH的局灶性定位体征多见;两者预后均与出血量有关,与再出血可能有关;PIVH再出血发生率较高,但预后优于SIVH。

Objective To study the etiology, clinical findings, and prognosis of primary and secondary intraventricular hemorrhage and to find the similarities and differences between them. Methods To retrospectively review the clinical data on cases with primary intraventricular hemorrhage （PIVA） （n = 22 ） and secondary intraventricular hemorrhage （SIVA） （n = 94）. Results The percentage of cases with the history of hypertension was respectively 50% and 78.7% in PIVH and SIVH group, and there was significant difference between them（ P 〈 0.05 ）. The clinical findings were similar between them,but localizing neurological signs were significantly more in SIVH group than in PIVH group（ P 〈0.05 ）. The rebleeding rate and mending rate were significantly higher in PIVH group than in SIVH group（ P 〈 0.05 ）. However, the mortality and morbidity was significantly higher in SIVH group than in PIVH group （ P 〈 0.05 ）. There were dramatica difference of mortality and mending rate between the different graeb grade in both of them （ P 〈 0.05 ）. The mortality of them after rebleeding were higher, but not significant different （P 〉 0.05 ）. Conclusion Hypertension is the main cause for PIVH and SIVH. Localizing neurological signs are more frequent in SIVH than in PIVH. Their prognosis is correlated with the magnitude of ventricular bleeding significantly, and with rebleeding possibly. The rebleeding rate is higher and the prognosis is better in PIVH than in SIVH.