高血压脑出血合并上消化道出血临床分析

目的 探讨高血压脑出血的出血部位、出血量与消化道出血发生率及预后的关系.方法 对96例脑出血患者的临床表现、出血部位、出血量、血糖、治疗方法 进行分析.结果 上消化道出血发生率分别为壳核出血组36.46%, 丘脑出血组32.29%,脑干出血组13.54%,脑叶出血组17.71%.高血压脑出血合并上消化道出血组病死率为43.75%.结论 脑出血合并上消化道出血常见丘脑、脑干等部位病变,且出血量大者发生率高,脑出血并上消化道出血提示预后不良,病死率高.     

140例脑出血患者心电图分析

目的 :观察不同部位急性脑出血患者心电图的异常及其表现形式。方法 :对 14 0例不同部位急性脑出血患者心电图结果进行分析。结果 :急性脑出血患者心电图异常率 75 4% ,心电图异常与出血部位有关 ,脑干、基底节及丘脑区出血心电图异常率高 ,多表现为心肌缺血性改变及心律失常 ,而心律失常又以传导阻滞、窦速、室早多见。结论 :急性脑出血患者并发心电图异常率高 ,对脑出血患者治疗应重视 ,尤其是脑干、丘脑、基底节区出血要重视心肌保护及对心肌缺血的治疗 ,防治各类心律失常的发生以减少心脏并发症 ,提高救治效果。     

140例脑出血患者心电图分析

目的：观察不同部位急性脑出血患者心电图的异常及其表现形式。方法：对１４０例不同部位急性脑出血患者心电图结果进行分析。结果：急性 血血患者心电图异常率７５．４％，心电图异常与出血部位有关，脑干、基底节及丘脑区出血心电图异常率高，多表现为心肌缺血性改变及心律失常，而心律失常又以传导阻滞、、窦带、室早多见。结论：急性脑出血患者并发心科异常率高，对脑出血患者治疗应重视，尤其是脑干丘脑、基底节区出血要重视心     

103例急性脑血管病患者的心电图改变与预后相关性分析

目的观察103例急性脑血管病患者的心电图改变情况,分析其与预后的关系。方法对我院2014-01—10收治的103例急性脑血管病患者的临床资料进行回顾性分析,所有患者均经头颅CT和(或)磁共振成像(MRI)检查确诊为急性脑血管病患者,对比心电图检查结果。结果 103例患者中心电图异常62例,异常率60.2%;其中49例脑梗死患者心电图异常25例(51.0%),46例脑出血患者心电图异常30例(65.2%),8例蛛网膜下腔出血患者心电图异常7例(87.5%),蛛网膜下腔出血患者心电图异常率明显高于脑梗死和脑出血患者(P0.05);心电图异常主要表现为ST-T改变、Q-T间期延长、心律失常、心肌缺血、T波改变、异常Q波、明显U波等。心电图异常与病变部位有关,病变位于丘脑患者心电图异常率显著高于其他部位(P0.05);心电图异常患者死亡8例(12.9%),心电图正常患者死亡2例(4.9%),差异有统计学意义(P0.05)。出现意识障碍36例,心电图异常率83.33%(30/36),无意识障碍患者的心电图异常率47.76%(32/67),差异有统计学意义(P0.01)。结论急性脑血管病的心电图异常率较高,且异常类型较多,心电图变化可作为判断病情及估计预后的重要指标之一,临床救治脑血管病患者时,应加强心电图异常的认识,采取有效综合治疗措施,改善脑血管病预后。     

急性脑出血并发神经源性肺水肿38例临床分析

我院在 2 0 0 0年 1月～ 2 0 0 2年 1月共收治脑出血患者2 6 6例 ,其中 38例合并神经源性肺水肿 (NPE) ,现从脑出血的部位及出血量与 NPE的关系分析如下。1　临床资料1.1　一般资料　 2 6 6例脑出血患者均经头颅 CT确诊 ,男 139例 ,女 12 7例 ,年龄 34～ 85岁 ,平均 6 4 .3岁。 0 .5～ 4 8小时入院 ,2 6 6例死亡 82例 (30 .8% ) ,合并 NPE患者均有意识障碍 ,大部分有中枢性高热、上消化道出血、心电图示ST- T异常。 38例 NPE患者死亡 36例 (94 .7% ) ,38例合并NPE患者继发脑室出血 30例 (80 % ) ,2 6 6例脑出血患者有原发性脑室出血…     

肝硬化并发脑出血与高血压脑出血的对比研究

【摘要】 目的   探讨肝硬化并发脑出血与高血压脑出血临床特点的区别。 方法  比较首都医科大学附属北京地坛医院收治的36例肝硬化并发脑出血患者与同期我院收治的52例高血压脑出血患者出血量、出血部位及临床特点。 结果  本研究中肝硬化并发脑出血平均出血量低于高血压脑出血平均出血量（P=0.038）。两组患者脑出血部位有显著差异（P<0.001）,肝硬化并发脑出血出血部位以脑叶（44.44%）为主,而高血压脑出血多位于基底节区（80.77%）。肝硬化脑出血多部位出血者占16.67%,而本组高血压脑出血中无多部位出血,两组有显著差异（P<0.001）。 结论  与高血压脑出血相比,肝硬化并发脑出血出血量较少,部位以脑叶多见,且亦多发。        

高血压脑出血CT特征及预后回顾性分析

目的 探讨高血压脑出血CT表现与预后的关系. 方法收集南方医院425例高血压脑出血患者的CT资料,对其在不同出血部位、年龄、病程、性别与预后间关系进行分析.结果 425例患者中男性269例(63.29%),女性156例(36.71%).男女比为1.72:1.本组以幕上脑实质出血为主(87.53%),平均出血量(30.042±7.905)mL,死亡39例(10.5%);幕下脑出血者平均出血量(7.838±5.761)mL,死亡2例(5.3%).各部位出血中,以基底节最多,多部位脑出血最少,不同年龄组出血部位构成比间差异有统计学意义(X<'2>=22.080,p=0.001).结论患病人数随年龄增长呈逐渐增多趋势,出血量多是死亡重要危险因素之一;老年人椎动脉迂曲扩张是高血压脑出血的一种保护机制;早期CT检查可确定诊断、明确治疗方法、初步预测预后情况.     

高血压脑出血与消化道出血

目的 研究高血压脑出血患者脑出血部位，出血量与消化道出血率及病死率的关系。方法 对２７０例脑出血患者，按脑出血部位，血肿量，有无脑室积血和中线结构移位，分别比较消化道出血率和病死率。     

急性脑出血的眼底出血及其与预后关系（附62例分析）

目的：研究急性脑出血患者的眼底出血及其与预后的关系。方法：对396例急性脑出血患者根据其不同的病因,出血部位、出血量、病情分级,比较其合并眼底出血的发生率;并分析有无眼底出血及不同部位眼底出血与急性脑出血病死率的关系。结果：由脑瘤和血液病引起的脑出血,脑干出血、出血量≥30ml及病情重者合并眼底出血发生率明显增高;合并眼底出血尤以玻璃体出血病死率高。结论：眼底出血是判断脑出血病情和预后的重要指标。     

高血压性脑出血CT影像学与预后相关性研究

目的 研究高血压性脑出血CT表现与预后的关系.方法 304例高血压性脑出血患者于入院当天行颅脑CT检查,并随访至发病后6个月,观察其预后与CT表现的关联.结果 出血量、出血部位及血肿是否破入脑室是估测脑出血患者预后的有效参数.将以上3个参数综合起来组建方程1与方程2来估测预后.另收集122例高血压性脑出血患者对方程进行复核.结论 通过方程1与方程2可以将出血量、出血部位及血肿是否破人脑室3个参数综合起来更确切地估测脑出血患者的预后.     

Predictive factors for tracheostomy in neurocritical care patients with spontaneous supratentorial hemorrhage

BACKGROUND: Up to 30% of patients with supratentorial intracerebral hemorrhage (ICH) require mechanical ventilation during the course of treatment. For these patients, tracheostomy is necessary in cases of protracted weaning. As only limited data exist about predictors for a tracheostomy in patients with ICH, the aim of this study was to investigate the frequency of tracheostomy and clinical findings that increase the risk for a tracheostomy in patients with supratentorial hemorrhage. METHODS: A total of 392 patients with supratentorial ICH were analyzed. The parameters age, gender, chronic obstructive pulmonary disease (COPD), Glasgow Coma Scale on admission, ganglionic or non-ganglionic localization, presence of ventricular hemorrhage, hydrocephalus, hematoma volume, and hematoma evacuation were investigated. The effects on the end-point tracheostomy were analyzed using multivariate regression analyses. RESULTS: The overall need for tracheostomy was 9.9% (16.3% in patients with ganglionic hemorrhage versus 2.8% in patients with non-ganglionic hemorrhages). 31% of the ventilated patients required tracheostomy. The risk for tracheostomy was increased eightfold in patients who developed hydrocephalus. The presence of ventricular blood, in general, showed no significant impact on the need for tracheostomy, whereas hemorrhage extending into the third and fourth ventricles in conjunction with hydrocephalus increased the risk for tracheostomy. The hematoma volume correlated positively with the risk for tracheostomy. CONCLUSIONS: Our study demonstrates that approximately 10% of patients with ICH require tracheostomy during the course of their disease. Presence of COPD, hematoma volume, ganglionic location of the hematoma, and the development of hydrocephalus are predisposing factors for tracheostomy.     

脑出血患者血清超敏C反应蛋白水平与出血量、病情及认知功能损害的关系

目的探讨脑出血患者血清超敏C反应蛋白(hs-CRP)水平与出血量、病情及认知功能损害的关系。方法 56例脑出血患者(脑出血组)根据血肿体积分为小血肿亚组(<15 ml,23例)、中血肿亚组(15～30 ml,18例)和大血肿亚组(>30 ml,15例);根据入院时美国国立卫生研究院卒中量表(NIHSS)评分分为轻度亚组(≤7分,19例)、中度亚组(8～14分,21例)和重度亚组(≥15分,16例);检测患者发病后第1、3、7 d及30名正常对照者(正常对照组)血清hs-CRP水平;脑出血患者血肿吸收后进行简易精神状态检查(MMSE)量表评分。结果脑出血组发病后1、3、7 d血清hs-CRP水平明显高于正常对照组(均P<0.001);并且在小、中、大血肿亚组间及病情轻、中、重亚组间依次显著升高(P<0.05～0.001);出现认知功能障碍患者血清hs-CRP水平显著高于无认知功能障碍患者(P<0.001)。结论血清hs-CRP水平升高越明显,提示患者脑出血量大、神经功能缺损程度重,并可能发生认知功能损害。     

Clinical discriminators of lobar and deep hemorrhages: the Stroke Data Bank.

Of the 1,805 patients with acute stroke enrolled in the Stroke Data Bank, 237 had parenchymatous hemorrhage. After excluding 34 secondary intracerebral and 31 infratentorial hemorrhage patients, a logistic regression analysis of the 172 patients with primary supratentorial intracerebral hemorrhage (ICH) elucidated clinical factors that distinguished the 65 patients with lobar hemorrhage (LH) from the 107 patients with deep hemorrhage (DH) located in the basal ganglia and thalamus. In LH, severe headache was more common than in DH, while hypertension and motor deficit were significantly less common. Patients with either LH or DH had a similar prognosis and mean Glasgow Coma Scale (GCS) scores, despite the hematoma volume measured on the initial CT being significantly greater for LH than DH. The presence of intraventricular extension (IVH) was more frequent in DH. The frequency of IVH increased with hematoma volume in LH, but remained constant for DH. Two CT variables (IVH and hematoma volume) that differed in these two hemorrhage groups were important predictors of coma (GCS less than or equal to 8) in a logistic regression model. Differences in the frequency of IVH may help explain why the degree of impairment in consciousness was similar in the two groups. Among patients with supratentorial ICH, location of the hematoma is related to both volume and IVH, which are important determinants of the level of consciousness.     

脑出血患者血清神经元特异性烯醇化酶的动态变化和意义

目的研究脑出血患者血清中神经元特异性烯醇化酶(NSE)动态变化的临床价值。方法采用酶联免疫吸附法对48例脑出血患者起病第1、3、7、14d血清NSE水平进行动态测定,神经功能缺损按斯堪的纳维亚卒中量表(SSS)标准进行评定。结果脑出血组各时间血清NSE水平明显高于对照组(P<0.001),并与出血量大小及SSS呈正相关。结论血清NSE的水平变化对判断脑出血量大小和预后有重要参考价值。     

The prognostic value of the CT scan in conservatively treated patients with intracerebral hematoma

Prognostic factors for survival and neurological recovery were assessed in 42 patients with nontraumatic intracerebral hematoma (ICH) diagnosed by CT scan. None underwent surgical evacuation of hematoma. CT scans were used to determine location and volume of ICH and presence or absence of intraventricular hemorrhage (IVH). Only 11 patients (26%) died and 17 patients (40.5%) recovered fully. Mortality was associated with: 1) loss of consciousness as a presenting symptom (63.5% mortality rate versus 13% when there was no loss of consciousness at the onset; p less than 0.01). 2) extension of the bleeding into the ventricular system (45% mortality rate versus 9% when hemorrhages were confined to brain parenchyma; p less than 0.01). 3) location of hematoma in the posterior fossa (mortality rate of 43% versus 23% for intrahemispheric hematomas). Mortality was unaffected by age of patients and size of ICH. Full neurological and functional recovery occurred mainly when estimated volume of hematomas was less than 15 cc and with lobar hematomas regardless of size. In survivors there is CT evidence of complete resolution of ICH. Our data indicates a favourable outcome in a relatively large percentage of patients with ICH treated conservatively and therefore questions the need for surgical evacuation of hematoma.     

脑出血与脑小血管病亚型及总负荷的关系研究

目的 探讨自发性脑出血的严重程度与脑小血管病（cerebral small vessel disease，CSVD）各亚型及总 负荷之间的关系。 方法 回顾性分析2013年8月-2017年8月于河南科技大学第一附属医院就诊的发病24 h内住院的 脑出血患者的临床资料。根据患者入院24 h内、3～5 d、10～14 d头颅CT检查结果及头颅MRI检查结 果，计算不同时间段血肿及水肿体积，评估腔隙（lacune，LA）、白质高信号（white matter hyperintensity， WMH）、扩大的血管周围间隙（enlarged perivascular space，ePVS）、脑微出血（cerebral microbleed，CMB） 的严重程度并计算总CSVD评分，分析脑出血的严重程度与CSVD各亚型及总负荷的关系。 结果 最终共纳入85例脑出血患者，其中脑叶出血33例（38.82%），深部出血52例（61.18%）。校正 年龄、平均动脉压、入院GCS评分、入院NIHSS评分后，在血肿体积的多元线性回归模型中，CMB数目与 不同时期血肿体积均正相关，WMH的Fazekas评分与不同时期血肿体积均负相关；校正年龄、平均动 脉压、入院GCS评分、入院NIHSS评分、血肿体积后，在水肿体积的多元线性回归模型中，ePVS与不同 时期水肿体积均呈负相关。CSVD总负荷与不同时期血肿体积均不相关，与入院24 h内水肿体积不相 关，与3～5 d、10～14 d水肿体积负相关。 结论 CMB数目越多，WMH的Fazekas评分越低，血肿体积越大。ePVS的存在可能是脑出血后水肿程 度较轻的标志；CSVD总负荷可以预测3～14 d脑水肿的严重程度。     

Incidence and prognostic significance of fever following intracerebral hemorrhage

OBJECTIVE: To investigate the incidence and prognostic significance of fever on presentation and during the subsequent 72 hours in patients with spontaneous supratentorial intracerebral hemorrhage (ICH). METHODS: We analyzed 251 patients. On admission, body temperature, Glasgow Coma Scale (GCS) score, age, sex, blood pressure, blood glucose level, and presumed origin of hemorrhage were analyzed. From the initial CT scan, hematoma volume, location, and presence of intraventricular hemorrhage were determined. From the first 72 hours, hematoma enlargement, duration of increased temperatures, blood pressure, and blood glucose level were determined. Outcome was classified on discharge with the Glasgow Outcome Scale (GOS) score. RESULTS: Outcomes included no symptoms in 23 (9%), moderate disability in 64 (26%), severe disability in 104 (41%), vegetative state in 5 (2%), and death in 55 (22%) patients. Prognostic factors retained from a logistic regression model with a dichotomized GOS scale (GOS score of 1 or 2 versus GOS score of 3 to 5) as response variables were GCS score of 7 or less, age older than 75 years, hematoma volume of more than 60 cm3, ventricular hemorrhage, and presence of a coagulation disorder (p < 0.05). Fever was associated with intraventricular hemorrhage. From 196 patients, data from the first 72 hours were analyzed. A total of 18 patients (9%) had normal temperatures throughout the study. The duration of fever (> or =37.5 degrees C) was less than 24 hours in 66 (34%), 24 to 48 hours in 70 (36%), and more than 48 hours in 42 patients (21%). Independent prognostic factors during the first 72 hours were duration of fever, secondary hemorrhage, GCS score of 7 or less, ventricular hemorrhage, hematoma volume of more than 60 cm3, duration of increased blood pressure of more than 48 hours, and duration of increased blood glucose of more than 48 hours. CONCLUSIONS: The incidence of fever after supratentorial ICH is high, especially in patients with ventricular hemorrhage. In patients surviving the first 72 hours after hospital admission, the duration of fever is associated with poor outcome and seems to be an independent prognostic factor in these patients.     

β-七叶皂甙钠治疗脑出血疗效观察

目的:探讨β-七叶皂甙钠对脑出血患者血肿吸收、周围水肿改善及神经功能恢复的影响。方法:将80例脑出血患者随机分为治疗组40例和对照组40例,分别于入组第1、7、21天利用CT测量血肿体积、病灶体积(血肿+水肿带),并行临床神经功能评分(CSS)。治疗组给予0.9%氯化钠注射液250ml加β-七叶皂甙钠注射液20mg,静脉滴注1次/d,连用10天。结果:治疗组病灶体积、血肿体积和CSS均较对照组明显改善(P<0.01),应用β-七叶皂甙钠治疗后第21天病灶体积由(22.8±6)ml变为(10.9±4)ml,血肿体积由(21±6)ml变为(8±5)ml,CSS由23±8变为8±6,对照组第21天病灶体积由(23.4±7)ml变为(21.9±5)ml,血肿体积由(22±6)ml变为(12±6)ml,CSS由24±7变为13±6。两组比较,差异有显著意义(P<0.01)。结论:β-七叶皂甙钠对组织损伤有抗炎、抗渗出及消水肿作用,β-七叶皂甙钠联合甘露醇治疗脑出血促进脑出血患者水肿消退,血肿吸收和神经功能改善,并可减少甘露醇的用量     

Prognostic Factors and Clinical Outcomes of Acute Intracerebral Hemorrhage in Patients with Chronic Kidney Disease

Objective

We conducted a retrospective study examining the outcomes of intracerebral hemorrhage (ICH) in patients with chronic kidney disease (CKD) to identify parameters associated with prognosis.

Methods

From January 2001 to June 2008, we treated 32 ICH patients (21 men, 11 women; mean age, 62 years) with CKD. We surveyed patients age, sex, underlying disease, neurological status using Glasgow Coma Scale (GCS), ICH volume, hematoma location, accompanying intraventricular hemorrhage, anti-platelet agents, initial and 3rd day systolic blood pressure (SBP), clinical outcome using the modified Rankin Scale (mRS) and complications. The severity of renal functions was categorized using a modified glomerular filtration rate (mGFR). Multifactorial effects were identified by regression analysis.

Results

The mean GCS score on admission was 9.4±4.4 and the mean mRS was 4.3±1.8. The overall clinical outcomes showed a significant relationship on initial neurological status, hematoma volume, and mGFR. Also, the outcomes of patients with a severe renal dysfunction were significantly different from those with mild/moderate renal dysfunction (p<0.05). Particularly, initial hematoma volume and sBP on the 3rd day after ICH onset were related with mortality (p<0.05). However, the other factors showed no correlation with clinical outcome.

Conclusion

Neurological outcome was based on initial neurological status, renal function and the volume of the hematoma. In addition, hematoma volume and uncontrolled blood pressure were significantly related to mortality. Hence, the severity of renal function, initial neurological status, hematoma volume, and uncontrolled blood pressure emerged as significant prognostic factors in ICH patients with CKD.     

Prognostic significance of initial clinical and instrumental parameters in spontaneous intracerebral hemorrhages

We retrospectively analyzed the records of 63 consecutive patients with spontaneous intracerebral hemorrhage (ICH) who had been treated in our neurological intensive care unit from 1981 to 1985 (aged 17 to 84 years). In this sample, the prognostic value of initial clinical and laboratory findings was studied. The following factors were significantly correlated with mortality: concomitant cardiac failure, general atherosclerosis, and chronic obstructive pulmonary disease; coma or deranged brainstem reflexes on admission; concomitant intraventricular or subarachnoid hemorrhage, hydrocephalus and midline shift on CT scan. ICH location did not significantly correlate with outcome. Among lobar ICH occipital hematomas carried the best prognosis. No prognostic importance was detected for age and gender, initial blood pressure, time interval between ICH and admission, ECG or angiographic findings, or laboratory values.