134例凝血功能障碍所致脑出血的临床特点分析

Clinical features and outcomes of intracerebral hemorrhage induced by coagulation dysfunction: analysis of 134 cases

目的分析凝血功能障碍所导致脑出血的临床特点,探讨有效的治疗方法。方法收集2000年1月至2016年8月本科收治的凝血功能障碍所致脑出血患者134例,分析其凝血障碍类型、治疗方式、病死率、出院时改良兰金量表评分(modified rankin scale,mRS)、围手术期并发症(血肿扩大、肺部感染、脑积水、上消化道出血、深静脉血栓等)。结果出院时按mRS评分评估患者的预后,病死(mRS:6分) 54例,严重残疾(mRS:3～5分) 47例,预后良好(mRS:1～2分) 33例;其中华法林和血液病所致脑出血的预后最差,病死率达50%以上。对于出血量为> 30～80 mL的脑出血患者,32例(47%)采取保守治疗,其中23例患者死亡,病死率为71. 9%; 36例(53%)采取手术治疗,其中16例患者死亡,病死率为44. 4%。手术组病死率显著低于保守治疗组(P <0. 05)。手术组病例住院时间为(17.02±5. 90) d,显著短于保守治疗组病例住院时间[(20. 09±5. 35) d,P <0. 05]。结论凝血功能障碍所致脑出血患者预后较差,应严密监测各项凝血功能,并在早期迅速纠正凝血功能,预防并发症;早期手术治疗对于血肿较大的凝血功能障碍性脑出血患者预后有改善作用。

Objective To analyze the clinical characteristics and outcomes of intracerebral hemorrhage induced by coagulation dysfunction and explore its optimal interventions.Methods From January2000 to August 2016,a total of 134 patients with cerebral hemorrhage caused by coagulation dysfunction were admitted in our department.The types of coagulation disorders,interventions,mortality,modified Rankin Scale(mRS)scores at discharge,and perioperative complications(hematoma enlargement,pulmonary infection,hydrocephalus,alimentary tract hemorrhage,and deep venous thrombosis)were analyzed in these patients.Results The prognosis of the patients was evaluated based on mRS scores at discharge.Among the134 patients,54 died(mRS score of 6),47 had severe disabilities(mRS scores of 3~5),and 33 had favorable prognoses(mRS scores of 1~2).The patients with intracerebral hemorrhage associated with the use of warfalin and hematologic disease had the worst prognosis with a mortality rate above 50%.In the patients with a hemorrhage volume of>30~80 m L,32 received conservative treatment and 36 underwent surgical interventions,and the mortality rate was significantly higher in the patients with conservative treatment than those undergoing surgical treatment(71.9%vs 44.4%,P<0.05);the average length of hospital stay wasalso significantly longer in the conservative treatment group than in the surgical group(20.09±5.35 vs 17.02±5.90 d,P<0.05).Conclusion The patients with intracerebral hemorrhage caused by coagulation dysfunction have poorer outcomes than those with hypertensive intracerebral hemorrhage.Early and effective interventions of coagulation dysfunction,close monitoring of potential complications and early surgical intervention can improve the outcomes of patients with large intracerebral hematoma.