脑出血早期血肿扩大48例分析

高血压脑出血是临床常见病、多发病,发病率为60～80/10万,在我国占急性脑血管病的30%左右,急性期病死率30%～40%。随着影像学技术的发展和普及,人们发现脑出血后血肿     

微创引流术用于治疗高血压性脑出血的概况

高血压性脑出血约占脑血管疾病的1/3,多发生在50～60岁有高血压动脉硬化的病人,年发生率（14～15）/10万,病死率占脑血管疾病的首位,内科治疗高血压性脑出血效果较差,病死率高达40%～70%[1],外科手术在高血压性脑出血中取得良好的疗效,及时有效清除颅内血肿可有效缓解占位效应造成的脑组织受损,     

自发性蛛网膜下腔出血的眼底改变与预后的关系

颅内血管破裂后 ,血液流入蛛网膜下腔称为蛛网膜下腔出血。临床上将蛛网膜下腔出血分为外伤性与非外伤性两大类。由颅脑外伤引起者称为外伤性蛛网膜下腔出血 ,非外伤性蛛网膜下腔出血又称为自发性蛛网膜下腔出血或软脑膜自发性出血。自发性蛛网膜下腔出血 ,其年发病率为 5～ 12 / 10万 ,我国 6城市调查年发病率为 4 / 10万 ,其患病率为31/ 10万。其发病率约占急性脑血管病的 7%～ 15 % ,仅次于脑血栓形成与脑出血 ,占急性脑血管病的第三位[1] 。本病容易复发 ,死亡率高 ,青壮年多见。发病原因主要为颅内动脉瘤、动静脉畸形、高血压动脉硬化…     

直视下小骨窗开颅手术治疗高血压脑出血

高血压脑出血是中老年人常见病、多发病。发病率约为50—80／10万,其致残率和死亡率均高,其治疗方式有骨瓣开颅、钻孔和锥颅减压等手术方式。本院2004年1月至2008年6月采用直视下小骨窗开颅手术治疗67例高血压脑出血患者,效果比较满意。     

高血压脑出血术后并发下肢深静脉血栓10例报告

高血压脑出血称出血性脑卒中,发病率为60～ 80/10万人/年[1],已成为基层医院最常见的病种之一,对于出血量大的患者往往需采取手术治疗,虽然随着医学技术不断进步及治疗手段的逐渐增多,致死、致残率有所下降,但术后仍可因一些并发症,严重影响其预后.下肢深静脉血栓形成(deep vein thrombosis,DVT)就是脑出血患者常见并发症之一[2].我们回顾性分析了2008年7月至2011年7月收治的10例高血压脑出血术后并发下肢DVT患者的临床资料,报道如下.     

脑血管病高龄患者的特征

一、人类寿命进入高龄,由于高血压治疗等普及,脑出血减少,而脑梗塞增加。据日本的调查(1905～1977年):1977年脑血管病死亡率为149.8/10万人口,其中脑出血50.6,脑梗塞62.9,其他36.3。尽管脑出血死亡率有逐年降低倾向,仍占脑血管病总数的36.3％。1977年脑血管病各年龄组死亡率与     

山东省滕州市2013—2021年脑出血发病率变化趋势分析

目的分析山东省滕州市2013—2021年开展高血压综合防控(简称高血压防控)9年间, 不同特征居民脑出血发病率的变化趋势。方法因滕州市自2013年起开展高血压防控, 故采用2013年1月1日至2021年12月31日脑出血新发病例监测数据统计脑出血发病率, 并分析其在不同特征居民之间分布的变化趋势。户籍人口信息来源于滕州市公安局, 以2020年全国第7次人口普查数据计算年龄和性别标化发病率。发病率的时间趋势和年龄趋势分析采用Cochran-Armitage趋势检验。结果滕州市2013—2021年总体脑出血粗发病率和标化发病率分别由97.30/10万和119.30/10万下降为52.13/10万和50.69/10万(Z=-9.93、-15.40, 均P<0.001), 两者均在2020年升高成峰, 与2019年同比分别升高了22.58%(χ2=24.02, P<0.001)和18.09%(χ2=17.08, P<0.001)。同期男女性发病率变化趋势与总体相似;男性发病率高于女性。脑出血发病率随年龄增加而增高;男性2020年≥45岁3个年龄段与2019年同比升高, 差异均...     

基层医院治疗高血压脑出血的现状分析

随着我国人民的物质生活水平的提高和老龄化社会的到来,高血压脑出血的发病率日益上升,高达50.6 ～80.7/10万[1],且病死率和病残率均很高,为我国人口死亡的三大主要疾病之一.众所周知,我国是一个农业人口大国,农村居民占80.0％左右,大部分高血压脑出血患者就治于县级基层医院.发病后有相当数量的病例需手术治疗[2-4].换言之,大量的手术是由基层医院的医生来进行,“十二五”期间新型合作医疗覆盖更广泛,患者所支付的费用更少,到基层医院就诊的患者必将大增.然而,这些医院医疗设施相对落后,手术器械不够先进齐全,专业技术人员缺乏,手术操作技术不够精湛等原因,患者预后往往不佳.因此,必须提高基层医院高血压脑出血的救治水平,保障人民健康.     

高血压脑出血术后再出血的临床探讨

目的探讨高血压脑出血术后再出血的原因及预防措施。方法对32例高血压脑出血术后再出血病人的临床资料进行回顾性分析。结果高血压脑出血术后再出血发生率10.8%(32/296),再次手术21例,保守治疗10例,放弃治疗1例。治疗结果按GCS评分评价。其中恢复良好11例,中残9例,重残4例,植物生存5例,死亡3例。结论高血压脑出血术后再出血的原因很多,针对可能导致再出血的诱因,采取积极的预防措施,可提高高血压脑出血的预后。     

脑出血患者高敏C反应蛋白的变化分析

目的分析自发脑出血患者血浆高敏C反应蛋白(hs-CRP)的变化与病情的关系。方法分析我科2009-2012年收治的自发脑出血64例患者,均无外伤病史,所有患者入院1~2d内查高敏C反应蛋白。结果高血压脑出血47例,非高血压性脑出血17例[hs-CRP(18.78±22.76)mg/L vs(6.85±8.32)mg/L,P=0.003 6];高血压中手术者10例,非手术者37例[hs-CRP(47.52±28.32)mg/L vs(11.01±12.55)mg/L,P=0.003 7]。结论高血压脑出血患者血浆hs-CRP值明显高于非高血压脑出血,且与患者病情严重程度相关,手术组血浆hs-CRP值明显高于非手术组,说明血浆hs-CRP可作为判断患者病情严重程度及预后监测指标之一。     

Spontaneous intracerebral hemorrhage

To determine the prognostic value of etiology and localization in spontaneous intracerebral hemorrhage, 896 patients with spontaneous intracerebral hemorrhage, as proven by CT, operation or autopsy, were retrospectively studied using univariate data analysis. Etiologies were hypertension in 63.5%, cerebrovascular malformations in 8.5% and abnormal hemostasis in 15% of the patients. In 23% no etiology was determined. Main localizations were cerebral lobes in 49.2%, basal ganglia in 34.4%, brain stem in 6.9%, cerebellum in 6.7% and primary intraventricular in 2.3% of the patients. Ventricular extension was present in 47.0%. A higher case fatality correlated with: 1) ventricular extension ( P <0.00001), 2) increasing age ( P =0.00005), 3) surgical treatment ( P =0.00010), 4) localization in basal ganglia ( P =0.0108) and 5) hypertension as only etiology ( P =0.01471). A lower case fatality was found in patients with cerebrovascular malformations ( P =0.00006) and when the hemorrhage was localized to the cerebral lobes ( P =0.0050). We conclude that etiology and localization are of prognostic value in spontaneous intracerebral hemorrhage.     

Oral-anticoagulant-related intracerebral hemorrhage

BACKGROUND: The characteristics, management and outcomes of patients who suffer intracerebral hemorrhage (ICH) while taking oral anticoagulants (OAC) are relatively unreported. DESIGN: Retrospective cohort study of consecutive cases with ICH associated with OAC. SETTING: A university-affiliated tertiary care hospital in Ontario, Canada. PATIENTS/PARTICIPANTS: 368 charts of individuals with a discharge diagnosis of ICH (ICD-9 code 431) between January 1993 and May 1998 were reviewed. MAIN RESULTS: 20 (5.4%, 95% confidence interval (CI): 3.1-7.7%) of the 368 ICHs occurred in people taking OAC. The median age of patients on OAC was 74 years (S.D.+/-9.8), and 70% (95% CI: 49-91%) were female. The median INR at presentation was 3.4 (intraquartile (IQR) range 2.2-4.4). Nine of 20 (45%) patients had INR values which exceeded the target range. The case fatality rate was 45% (95% CI: 23-67%). Approximately 2.8 years after the initial ICH, 9 of the 11 patients who survived the initial ICH were still alive, and 6 had restarted OAC. CONCLUSIONS: ICH is a serious complication in patients taking OAC, and the case-fatality rate is high. Given the increasing use of OAC in patients with cardiovascular disease, the relative benefits and risks of this therapy must be weighed carefully.     

Post-traumatic intracerebral hematoma

Fifty-five cases of post-traumatic intracerebral haematomas are analyzed, discussing the diagnostic value of such preliminary methods as plain skull films, EEG, echoencephalography. These methods, together with clinical findings make the diagnosis of intracerebral haematoma likely. The final diagnosis was based on carotid arteriography and computerized tomography of the brain, which provided additional information on traumatic brain damage. The diagnostic sensitivity of CT was higher. The considerable prognostic importance of the degree of consciousness disturbances and their duration is stressed. In the group of patients with lucidum intervallum the mortality was higher. Four patients were treated conservatively since CT demonstrated in them only small haematomas without displacement of the ventricles. The remaining patients were treated surgically removing the haematomas through craniotomy or craniectomy. In 54% of these cases improvement was obtained. The 33% mortality was moderate as compared with previous reports.     

Anticoagulant-associated intracerebral hemorrhage

The incidence of anticoagulant-associated intracerebral hemorrhage (AAICH) quintupled during the 1990 s, probably due to increased warfarin use for the treatment of atrial fibrillation. Anticoagulant-associated intracerebral hemorrhage now accounts for nearly 20% of all intracranial hemorrhage (ICH). Among patients using warfarin for atrial fibrillation, the annual risk of ICH in trials is 0.3 to 1.0%. Predictors of potential anticoagulant-associated hemorrhage are increasing age, prior ischemic stroke, hypertension, leukoaraiosis, the early period of warfarin use, higher intensity anticoagulation, and antiplatelet use in addition to anticoagulation. Compared with other intracranial hemorrhage patients, anticoagulated patients have a greater risk of hematoma expansion, subsequent clinical deterioration and death, necessitating vigorous reversal of their coagulopathy. Recommended methods of warfarin reversal are administration of intravenous vitamin K and either prothrombin complex concentrates or fresh frozen plasma. Reversal of unfractionated heparin is accomplished with intravenous protamine sulfate. Surgical treatment of intracranial hemorrhage may be life saving in select cases, but has not reduced morbidity or mortality in large randomized trials.     

Recurrent intracerebral hemorrhage

Objective: In order to study the clinical manifestation and risk factor of recurrent intracerebral hemorrhage(ICH).Methods:The 256 patients were analysed who admitted to our hospital for intracerebral hemorrhage between 1995 and 1997.The 15(5 .86%)patients had a recurrent ICH.There were 9 men and 6 women and the mean age of the patients was 63.5 ± 6.4years at the first bleeding episode and 67.8± 8. 5 years at the second. The mean interval between the two bleeding episodes was 44.6 ± 12.5 months. The 73.3%patients were hypertensive .′The site of the first hemorrhage was ganglionic in 8 patients , ]ohar in six paients and brainstem in one .The recurrent hemorrhage occurred at a different location from the previous ICH.The most common pattern of recurrence was “ganglionic -ganglionic” (7 patients), lobar - ganglionic (3 patients), lobar-lobar(three patients), which was always observed in hypertensive patients. The outcome after the recurrent hemorrhage was usually poor. By comparison with 24 patients followed up to average 47.5± 18.7 months with isolated ICH without recurrence .Only lobar hematoma and a younger age were risk factors for recurrences whereas sex and previous hypertension were not. The mechanism of recurrence of ICH were multiple(hypertension, cerebral amyloid angiopathy).Contral of blood pressure and good living habit after the first hemorrhage may prevent ICH recurrences.     

Spontaneous intracerebral hemorrhage

Spontaneous intracerebral hemorrhage (sICH) is defined as bleeding within the brain parenchyma, and occurs twice as commonly as subarachnoid hemorrhage, but is equally as deadly. Risk factors for sICH include hypertension, advanced age, leukoaraiosis, prior ICH, renal failure, use of anticoagulant drugs, and cerebral amyloid angiopathy. When a patient is clinically suspected of having sICH, head computed tomography scan is the standard diagnostic tool. However, newer magnetic resonance neuroimaging techniques may aid in determining the underlying pathology and aid in prognosis. Supportive care and blood pressure management are important in the care of patients with sICH. Ongoing research is aimed at determining a safe blood pressure goal that may also prevent expansion of hemorrhage. Hemostatic medications and neuroprotectants have thus far not shown clinical improvement. Although several neurosurgical trials have failed to demonstrate benefit for surgical evacuation of sICH, multiple research trials are ongoing investigating acute blood pressure control, deep or basal ganglionic hemorrhage evacuation via minimally invasive approach (MISTIE; http://mistietrial.com/default.aspx), lobar ICH evacuation (STICH; II http://research.ncl.ac.uk/stich/), and intraventricular thrombolysis with tissue plasminogen activator (tPA) (CLEAR III; http://biosgroup-johnshopkinsmedicine.health.officelive.com/default.aspx).     

Warfarin-associated intracerebral hemorrhage

Intracerebral hemorrhage (ICH) is the most serious complication of oral anticoagulant therapy (OAT), with mortality in excess of 50%. Major risk factors are advanced patient age, elevated systolic blood pressure, intensity of anticoagulation, and previous cerebral ischemia. A number of acute treatments are available, but all have significant side effects and no randomized clinical trials assessing clinical outcome have been performed. Future trials will have to address choice and dose of agent, the timing of its administration, and the risk of side effects.