原发性脑室内出血47例前瞻性临床研究

Prospective clinical study of 47 cases with primary intraventricular hemorrhage

目的研究并明确原发性脑室内出血（HVH）的病因、临床特征、危险因素和预后。方法前瞻性地制订严格的纳入标准，连续收集2008年9月至2010年10月在我院诊治的HVH患者，对其临床资料、辅助检查、治疗方式及预后进行分析。结果共纳入47例患者，男27例，女加例，比例为1．35：1，平均年龄（52．6±12．6）岁。GCS评分10．8±2．6；Graeb评分5．8±2．6；合并梗阻性脑积水者22例（47％）；确诊Moyamoya病12例（26％），动静脉畸形10例（21％）和动脉瘤5例（11％），病因不详20例（43％）。单纯开颅手术12例（26％），开颅联合脑-硬膜-血管-肌肉血管融合术（EDAMS）6例（13％），单纯EDAMS治疗5例（11％），EDAMS联合吻合手术1例（2％），脑室外引流3例（6％），γ－刀治疗8例（17％），介入治疗2例（4％），保守治疗10例（210）。患者均随访6个月，住院死亡7例（15％），6个月末mRS评分〈3分者31例（66％），≥3分者9例（19％），出院后无死亡病例。结论HVH临床少见，发病年龄相对较小；Moyamoya病、动静脉畸形和动脉瘤是排前三位的病因，高血压是最主要的危险影响因素；通过合理治疗，HVH可获得较好的预后；年龄、高血压、糖尿病、吸烟史及入院时GCS评分可不同程度预测住院死亡率。

Objective To define the clinical features, risk factors, etiology and prognosis of primary intraventricular hemorrhage （PIVH）. Methods We prospectively formulated strict inclusive criteria and consecutively collected patients with diagnosis and treatment for PIVH in our hospital from September 2008 to October 2010. The clinical information, laboratory examinations, treatment and prognosis were analyzed. Results 47 patieuts（27 males and 20 females, a ratio of 1.35： 1, with an average age of 52. 6± 12. 6 years old） were internalized in the study. The initial symptoms were headache in 24 cases, and disturbance of consciousness in 23 cases. The GCS score was 10. 8 ± 2. 6 and Graeb score was 5. 8 ± 2. 6. Combined obstructive hydrocephalus was found in 22 cases （47%）. The diagnosis of moyamoya disease was confirmed in 12 patients （26%）, while vascular malformations in 10 （21%） and aneurysm in 5（11% ）. The other 20 patients had unknown etiology （43%）. Craniotomy was performed in 12 cases （26%）, craniotomy combined EDAMS in 6（13%）, EDAMS in 5 （11%）, EDAMS combined with anastomosis in 1（2% ）, ventricular drainage in 3（6% ）, T-knlfe in 8（17% ）, interventional therapy in 2（4% ）, and conservative treatment in 10 patients （21%）. All patients were followed -up for 6 mouths. 7 cases of hospital mortality （ 15% ） were found. 31 patients （66%） got less than 3 points of mRS score at the end of the 6th month, and 9 patients （19%） had greater than or equal to 3 points. After discharge there was no death. Conclusion PIVH is relatively rare in clinical practice. The age of onset for PIVH is relatively small. Moyamoya disease, AVM and aneurysm are ranked the top three causes, and hypertension is the most important risk factor. Through reasonable treatment, patients with PIVH could get better prognosis. Age, hypertension, diabetes, smoking history and admission ; score could predict hospital mortality in varying degrees.