脑出血后脑休克期临床研究

Clinical Study on Cerebral Shock at er Intracerebral Emorrhage

目的总结脑出血中后脑休克期的临床特征，旨在提高对脑休克的重视。方法选择2010年2月-2011年12月收治的136例脑出血患者，人院后48h完成巴塞指数（BI）评分、NIH卒中量表（NIHSS）评分，并分为有脑休克组和无脑休克组，比较两组的NIHSS、BI评分；并以NIHSS评分为基线，将136例患者配对为有脑休克组39例，无脑休克组39例（以NIHSS评分相差1～2分内进行配对）；6个月后，按mRS量表将两组配对患者分为预后良好和不良，比较两组预后良好率。结果136例卒中患者，有脑休克者95例，无脑休克者41例，脑出血后休克组患的NIHSS评分高于无休克组，巴塞指数评分低于无休克组；6个月后，两组配对患者中，有脑休克组死亡2例，失访1例，预后良好11例，预后不良25例；无脑休克组死亡1例，失访2例，预后良好29例，预后不良7例，伴有脑休克的患者预后差于无脑休克组。结论伴有脑休克的脑出血患者神经缺损症状重，生活自理能力差，脑休克期影响脑出血患者预后。对伴有脑休克的卒中患者及早进行干预，可望改善卒中患者预后。

Objective To analyze the clinical characteristics of cerebral shock after intracerebral emorrhage （ICH） to enhance the understanding of cerebral shock after ICH. Methods A total of 136 patients with ICH admitted to hospital from February 2010 to December 2011 were enrolled in this study. Barthel index （BI） and NIH Stroke Scale （NIHSS） were finished within 48 hours. All the patients were divided into cerebral shock group and no cerebral shock group. All of the 136 patients were matched to shock group （39 cases） and no shock group （39 cases） by the baseline NIHSS score. After 6 months, we judged the prognosis of stroke patient by mRS and compared the prognosis between the two groups. Results In 136 patients, 95 had cerebral shock （69.85%）, and 41 didn＇t. The NIHSS score in the shock group was higher than that in the no shock group, but the BI score was lower in the shock group. Six months later, 2 patients died in shock group, in which lost follow up was in 1, good prognosis in 11, and poor prognosis in 25. In no shock group, 1 patient died, 2 were lost of follow up, and the prognosis was good in 29 and poor in 7. The prognosis in the shock group was poorer than that in the no shock group. Conclusions There are neurological deficit symptoms and poor self-care ability in ICH patients associated with brain shock. The period of brain shock impact the prognosis of the patients with cerebral hemorrhage; early functional rehabilitation for stroke patients with brain shock is expected to improve the prognosis of patients with cerebral stroke.