中老年原发性脑干出血48例临床分析

Clinical analysis of primary brain stem hemorrhage in patients aged 40 to 71 years

目的研究中老年原发性脑干出血患者临床表现的多样性与影响预后的因素。方法观察并收集1998～2008年经CT确诊为原发性脑干出血的中老年患者,分析患者的有关临床资料、预后及影响预后的因素。结果本组病例共48例,最终死亡36例,痊愈出院2例,伴有神经功能障碍出院10例,首发症状较多见的是意识障碍、头痛、呕吐、语言障碍、肢体无力,体征较多见的是眼部体征、颅神经障碍、运动障碍等。存活组与死亡组在下列项目上差异具有统计学意义(P<0.05):出血量>5ml,来院时昏迷,12h内出现呼吸抑制或呼吸衰竭,高热。结论中老年原发性脑干出血患者临床表现复杂,死亡率高,出血量>5ml、昏迷、短期内呼吸衰竭和高热是预后不良的主要危险因素。

Objective To analyze the clinical features and prognostic factors of primary brain stem hemorrhage in patients aged 40 to 71 years. Methods Patients diagnosed as primary brain stem hemorrhage by computed tomography （CT） were collected from 1998 to 2008. Clinical data and the prognostic factors were analyzed. Results Forty-eight patients were included in our study. Among them,36 patients died in hospital and 12 were discharged,including 2 completely recovered and 10 with neurological deficit. The initial symptoms in these cases were manifested in terms of conscious disturbance,headache,vomiting,and dysphasia,and physical signs were ocular signs,cranial nerves morbidities and dyskine-sia. There were statistically differences between the survival group and the death group （P 0.05） on the following aspects：hemorrhage volume （5 ml）,coma,respiratory inhibition or failure within 12 hours and hyperthermia. Conclusions Our results suggest that the clinical features in primary brain stem hemorrhage cases are complicated,and the mortality is still high. Hemorrhage volume （5 ml）,coma,respiratory failure within 12 hours and hyperthermia are the main risk factors that affect the prognosis.