高血压脑出血并发消化道出血51例临床分析

Clinical analysis of cerebral hemorrhage complicated with gastrointestinal bleeding in 51 hypertension patients

目的分析高血压脑出血(HICH)并发消化道出血的临床特点。方法对2008年1月至2012年6月在我院就诊的197例HICH患者的临床资料行回顾性分析,其中51例(25.9%)合并消化道出血。依据HICH合并消化道出血与否分组,分析性别、年龄、就诊时血压、GCS评分(意识状态)、脑部出血位置、破入脑室与否、中线结构移位与否、出血量、病死率等因素与并发消化道出血的关系。结果 HICH并发消化道出血与其脑部出血位置、出血破入脑室与否、中线结构移位与否及意识状态(昏迷)等因素有关(P<0.05);出血位于脑干、丘脑部位、并破入脑室或有中线结构移位、出血量大、昏迷程度重者,消化道出血发生率明显升高(P<0.05);HICH并发消化道出血的独立危险因素有GCS评分≤8分,单纯基底节区出血,基底节出血且破入脑室,出血破入脑室(或中线结构移位,或有意识丧失),脑出血量≥30 mL。本组197例HICH患者,死亡40例(20.3%),其中合并消化道出血组,死亡23例(45.1%);HICH合并消化道出血患者的预后明显比未合并出血的患者差,且消化道出血发生时间越早,患者病死率越高(P<0.05);瞳孔散大,GCS评分≤8分,并发消化道出血及3 d内发生消化道出血,均是HICH死亡的独立危险因素。结论掌握HICH并发消化道出血相关危险因素后,针对原发病行积极防治,可保护胃黏膜,有效降低消化道出血并发率。

Objective To observe the clinical characteristics of hypertensive intracerebral hemorrhage（HICH） combined with gastrointestinal bleeding.Methods Clinical data of 197 patients with hypertensive intracerebral hemorrhage were reviewed and analyzed,of which 51 patients was combined with gastrointestinal bleeding.All the patients were divided into two groups based on whether gastrointestinal bleeding was involved.Relations of gender,age,blood pressure,GCS score,location of brain hemorrhage,intraventricular hemorrhage caused by blood flooding,spilling into ventricle or not,midline shift,bleeding volume,or fatality rate with gastrointestinal bleeding were explored.Results HICH coupled with gastrointestinal bleeding is related to brain hemorrhage location,intraventricular hemorrhage caused by blood flooding,midline shift,state of consciousness（P 0.05）.The rate of gastrointestinal bleeding was increased significantly by hemorrhage of brainstem and thalamus,intraventricular hemorrhage caused blood flooding,midline shift,huge bleeding volume and coma.Of 197 patients in the present study,40 patients died（20.3%）,among which 23（45.1%） died from HICH coupled with gastrointestinal bleeding.Compared with the other group,the prognosis for patients with HICH and gastrointestinal bleeding was significantly worse.The early the bleeding time,the worse the prognosis.Mydriasis,GCS scores ≤8,gastrointestinal bleeding and gastrointestinal bleeding in the early three days are the independent risk factors for the death of HICH.Conclusion Based on the risk factors,active treatment in primary diseases can protect gastric mucosa,reducing gastrointestinal bleeding.