大面积脑梗死的临床特点及预后分析

Clinical Characteristics and Prognosis of Massive Cerebral Infarction

目的分析大面积脑梗死患者的临床特点及影响预后的危险因素。方法选取2017年5月至2018年5月在我院治疗的102例大面积脑梗死患者,按照病死时间分为病死组(发病1个月内病死,28例)和未病死组(74例),对其临床资料进行回顾性分析。结果大面积脑梗死患者的主要表现为头痛、恶心、呕吐、尿失禁、昏迷、中枢性高热等,部分患者伴有消化道出血、肺部感染等,患者均出现不同程度的肢体感觉障碍以及双眼偏向梗死灶侧凝视症状。102例患者中有28例(27.45%)在发病后1个月内病死。病死原因主要为脑疝、多器官衰竭,存活患者大多都出现了较为严重的后遗症。大面积脑梗死患者病死的独立危险因素包括高龄、脑室中线移位较大、继发肺部感染、单纯保守治疗(P<0.05)。结论大面积脑梗死患者的临床特点比较明显,病死率较高,临床上应针对高龄、脑室中线移位较大、继发肺部感染、单纯保守治疗的患者加强监护和治疗,以最大限度的改善患者的预后。

Objective To analyze the clinical characteristics of large-area patients with cerebral infarction and the risk factors affecting prognosis.Methods A total of 102 patients with large-area cerebral infarction who were treated in our hospital from May 2017 to May 2018 were divided into death group(death within 1 month of onset:28 cases)and non-dead group(74 cases),a retrospective analysis of its clinical data.Results Large areas of cerebral infarction mainly showed headache,nausea,vomiting,urinary incontinence,coma,central hyperthermia,etc.Some patients were accompanied by gastrointestinal bleeding,pulmonary infection,etc.,patients with varying degrees of limb sensory disturbance,and binocular deviation to the infarct side gaze symptoms.Of the 102 patients,28(27.45%)died within 1 month after onset.The main causes of death are cerebral palsy and multiple organ failure.Most of the surviving patients have more serious sequelae.The independent risk factors for large-scale cerebral infarction were age,ventricular midline shift,secondary pulmonary infection,and conservative treatment(P<0.05).Conclusion The clinical features of patients with large area cerebral infarction are obvious,and the mortality rate of patients is high.It is necessary to strengthen the monitoring and treatment for patients with advanced age,large midline ventricular shift,secondary pulmonary infection and simple conservative treatment.To maximize the patient's prognosis.