影响脑出血预后因素的探讨

Investigation on the Factors of Affecting Prognosis in Cerebral Hemorrhage

目的 :探讨影响脑出血预后的因素。方法 :对近3a收治的267例脑出血患者进行回顾性分析。结果 :在有意识障碍患者中 ,浅、中、深度昏迷病人的病死率分别为12%、48 %和83%。入院时血压高于正常者203例 ,急性期最高血压达240mmHg/150mmHg,血压持续高于210mmHg/135mmHg者病死率达37 1 %。不同部位死亡分别为 :两个或两个以上部位9例 ,基底节区31例、丘脑10例、内囊区8例、外囊区7例、小脑2例、脑干7例、原发性脑室出血2例。出血量>40ml者死亡37例。结论 :意识障碍越深、血压越高 ,则病死率越高。出血部位、出血量及出血速度对脑出血预后有较大影响 ,同一部位 ,出血速度越快 ,出血量越大 ,脑疝发生越早 ,则抢救越困难 ,预后越差。

Objective:To study the factors of affecting the prognosis in cerebral hemorrhage.Methods:Retrospective analysis to the clinical data of 267 cases with cerebral hemorrhage was carried out in the past 3 years.Results:The mortalities of light coma,moderate coma and deep coma's patients were 12%,48% and 83% respectively.As they admitted,203 cases had hypertension.The highest blood pressure in their acute stages reached 32/20 Kpa.The mortality was 37 1% in the patients whose blood pressures were over 28/18 Kpa.As the hemorrhage position was different,the mortality was different too.Of them,9 cases had two or more hemorrhage positions; the hemorrhage position of 31 cases was in basilar ganglion;the hemorrhage position of 10 cases was in thalamus;the hemorrhage position of 8 cases was in internal capsula;the hemorrhage position of 7 cases was in external capsula;the hemorrhage position of 2 cases was in cerebellum;the hemorrhage position of 7 cases was in cerebral truncus;the hemorrhage position of 2 cases was in cerebral ventricle.The hemorrhage volume of 37 cases died patients was over 40 ml.Conclusions:The deeper consciousness disorder and the higher blood pressure are,the higher mortality is.Hemorrhage position,volume and speed affect obviously the prognosis.At the same hemorrhage position,the faster hemorrhage speed and the larger hemorrhage volume are and the earlier hernia of brain occurs,the more serous prognosis is.