大面积脑梗死68例临床特点分析

Clinical study of characteristics of large cerebral infarction: 68 case report

目的探讨大面积脑梗死的临床特点及其与预后的关系。方法回顾性分析 68例大面积脑梗死患者的高危因素、起病、临床经过、治疗及预后、头颅CT变化及颈内动脉超声检查结果。结果本组患者中 ,脑栓塞 2 8例、脑血栓形成 40例 ;治愈 6例、进步 3 4例、无好转 11例、死亡 17例。结论梗死面积与预后有一定关系 (P <0 .0 5 )。颈内动脉粥样硬化多发斑块和老年人非瓣膜性心房纤颤是大面积脑梗死的主要栓子来源。死亡病例 64 .7%归因于脑疝和继发感染。超早期 ( <6h)头颅CT显示异常者死亡率为 62 .5 % ,中线移位者死亡率 42 .9% ,均提示预后不良。

ObjectiveTo explore clinic features of large cerebral infarction and the relationship between infarcted area and prognosis.MethodsClinic materials such as dangerous factors, onset, course, treatment and prognosis, brain CT changes and internal carotid artery ultrasonic examinations of 68 patients with large cerebral infarction were analyzed retrospectively.ResultsThere were 28 cases caused by cerebral embolism, and 40 cases caused by cerebral thrombosis. 6 cases got recovery, and 34 cases, progress, and 11 cases,no progress, and 17 cases, death. ConclusionThe infarcted area was significantly related to prognosis ( P<0.05). Internal carotid artery frequently occurring atheromas and senile non-valve atrial fibrillation were major embolic origins for large cerebral infarction. 11 out of the 17 deaths could be attributed to brain herniation and secondary infection. The early abnormal brain CT showed that the rate of mortality was 62.5%, and the rate of mid-line dislocation was 42.9%. Either of them indicated that prognosis was bad.