急性危重型脑血管病并发多系统脏器衰竭附215例分析

Acute severe cerebrovascular disease complicated with MSOF: Analysis of 215 cases

我科1986至1990年收治危重型急性脑血管病并发MSOF215例(男153例、女62例),其中60～70岁110例,占51.1％。既往史以高血压最多,113例占52.6％,出血87例,梗塞102例,SAH26例。死亡161例占74.9％。作者分析了215例急性危重型脑血管病合并MSOF的临床表现、不同器官衰竭的频度、顺序及器官衰竭数目与预后的关系。危重型脑血管病合并MSOF主要原因为脑水肿,尤为高颅压所致神经体液调节紊乱。另外,在缺血性中风再灌注后脑损伤,通过Ca^(2+)自由基、白细胞三烯等机制可进一步加重脑水肿和高颅压。在治疗方面应强调脱水剂、激素、抗自由基、钙离子拮抗剂、莨菪类药物的联合应用,并对重症脑血管病急性期严密监测生命体征、脑电图和心电图等。

This paper presents 215 patients (153 males ad 52 females) with acute severe cerebrovascular disease compli- cated with MSOF who were admitted to the Neurology Department of Tangsban Workersr' Hospital from 1986 to 1990 of these patients, 26 had subarachnoid hemorrhage (SAH), 87 cerebral hemorrhage, and 102 cerebral infarc- tion. 51. 1% of patients (110/215) ranged in age from 60 to 70 years. 52.6% of them (113/215) had a history of hypertension. The mortality rate was 74. 9% (116/ 215). The clinical characteristics of acute severe cere- brovascular disease complicated with MSOF, such as the frequency and sequence of the various organ system fail- ure, and the relationship between the prognosis and the number of the impaired organs in different types of acute severe cerebrovascular disease were analyzed. Our data emphasize the importance of the impairement of neurohor- mortal regulation due to cerebral edema and intracranial hypertension in the pathogenesis of acute severe cere- brovascular disease complicated with MSOF. Moreover, is- chemic stroke reperfusion injury mediated through events such as elevated intracellular calcuim, free radicals, and leukotrienes may further exacerbate cerebral edema and intracranial hypertension. Osmotherapy, corticosteroids, free radical scavengers, calcium antigonists and some cbi- nese herbal medicines proved to be with good results. In- tensive monitorings of vital signs, ECG, and EEG are rec- ommended at the acute stage of severe cerebrovascular disease.