无昏迷丘脑出血患者瞳孔散大临床分析

Clinical analysis of thalamic hemorrhage in patients with dilated pupil without coma

目的分析瞳孔散大不伴意识昏迷丘脑出血患者的病因、发病机制、临床特点及治疗。方法回顾性分析中国人民解放军联勤保障部队第987医院神经外科2014-01—2020-12收治的符合纳入标准的37例丘脑出血患者的影像检查、临床表现,分析其临床特点,总结其诊治经验。结果瞳孔散大不伴意识昏迷的丘脑出血患者均具有单侧或双侧瞳孔扩大,对光反应迟钝,但意识障碍程度不深,意识朦胧至清醒,GCS评分≥9分,偶有恶心呕吐,部分伴脑室扩大。本组患者好转32例,放弃治疗3例,死亡2例。结论丘脑出血出现瞳孔散大,但不伴意识昏迷患者与基底节及大脑半球脑出血引起的瞳孔散大患者发病机制与治疗措施有所不同,加强脱水降颅压是主要措施,早期发现、及时诊治能降低患者的病残率和病死率。

Objective To study the etiology,pathogenesis,clinical characteristics and treatment of thalam⁃ic hemorrhage in patients with dilated pupil without consciousness.Methods A retrospective analysis of the imag⁃ing examinations and clinical manifestations of 37 patients with thalamic hemorrhage who met the inclusion crite⁃ria admitted to the Department of Neurosurgery,987th Hospital of the Joint Service Support Force of the Chinese People’s Liberation Army from January 2014 to December 2020.Clinical characteristics were analyzed,and the di⁃agnosis and treatment experience were summarized.Results The thalamic hemorrhage patients with dilated pupil without conscious coma had unilateral or bilateral dilated pupil,dull response to light,but the degree of conscious⁃ness disorder was not deep,the consciousness was hagy to awake,the GCS score≥9,sometimes nausea and vomit⁃ing,and some of them were accompanied by ventricular dilation.In this group,32 patients improved,3 patients gave up treatment,and 2 patients died.Conclusion Dilated pupil in thalamic hemorrhage,but the pathogenesis and treatment measures are different between patients without consciousness and patients with dilated pupil caused by cerebral hemorrhage in basal ganglia and cerebral hemisphere.Enhance dehydration and reduce cranial pres⁃sure are the main measures.Early detection and timely diagnosis and treatment can reduce the rate of disablement and mortality of such patients.