高血压性脑出血并发症与预后的关系

目的探讨高血压性脑出血4种并发症与预后的关系。方法分析236例高血压性脑出血患者的临床资料，将其死亡与否作为应变量，以其并发症(中枢性高热、上消化道出血、继发感染和器官功能障碍)的有无作为自变量。用Logistic回归对数据进行分析。结果单因素Logistic回归分析显示在高血压性脑出血的并发症中，中枢性高热、继发感染和器官功能障碍3种并发症的Exp(B)值具有统计学意义。虽然上消化道出血的P值接近显著水准，但Exp(B)值远小于另外3种并发症。控制出血部位、出血量后进行的多因素Logistic回归分析显示了类似的结果。结论中枢性高热、继发感染和器官功能障碍3种并发症是影响高血压性脑出血预后的危险因素。     

平均动脉压与脑出血病死率的相关关系分析

高血压性脑出血伴有明显血压升高的患者其平均动脉压(MAP)亦相应增高。本组依据患者起病时及发病治疗后2～6h的平均动脉压的大小，对患者的病死率作相应的探讨，并提出该病急性期间的处理办法。     

亚低温对实验性脑出血大鼠病死率影响的实验研究

目的观察32℃亚低温对实验性脑出血大鼠24h内病死率和脑组织钙含量的影响。方法将134只大鼠分成两组:①68只大鼠用于病死率观察;②66只大鼠用于脑组织钙含量测定。两组再分成假手术对照组、常温脑出血组及亚低温脑出血组。结果常温组24h内病死率为36.7%,亚低温组为4.6%;脑组织钙含量常温组较对照组和亚低温组为高。结论亚低温治疗能减少脑出血后脑组织钙的增加,减少钙平衡失调,显著减少实验性脑出血大鼠24h内病死率。     

血肿穿刺引流治疗脑出血手术时机对病死率的影响

目的探讨血肿穿刺引流治疗脑出血手术时机对病死率的影响。方法选择我院2011-01—2012-01收治的86例脑出血患者为观察对象,随机分成观察组与对照组,观察组行超早期手术,即在患者发病7h内进行手术,平均（4.62±1.36）h;对照组行早期手术,即在患者发病后7～24h内进行手术,平均（17.34±2.45）h。观察组49例,对照组37例,2组患者一般资料比较,差异无统计学意义（P〉0.01）。比较2组患者术后病死率。结果观察组病死率6.12%,对照组18.92%,观察组明显低于对照组,差异有统计学意义（P〈0.01）。结论对脑出血患者进行超早期穿刺引流能尽早减轻血肿周围脑组织损伤,从而减少并发症,降低病死率。     

高血压脑出血血肿周围水肿的危险因素分析

目的探讨高血压脑出血血肿周围水肿的独立危险因素。方法回顾性分析符合纳入条件的36例高血压脑出血患者的临床资料。其中发生血肿周围水肿扩大者17例,未发生血肿周围水肿扩大者19例。对患者的一般资料、术前搬运、发病到手术间隔时间、血压、高血压病程、出血量、出血位置、血肿侧别、血肿形状等可能影响血肿周围水肿的因素进行单因素分析。对单因素分析有统计学意义的结果(血压,出血位置,术前搬运)建立Logistic回归模型,分析血肿周围水肿的独立危险因素。结果 Logistic回归分析结果显示,高血压病程(P=0.007)和血肿形状(P=0.008)与血肿周围水肿密切相关;而血压、出血位置以及术前搬运等无统计学意义。结论较长的高血压病程以及不规则的血肿形状可能是高血压脑出血血肿周围水肿的危险因素。     

入院体温变化对急性脑梗死影响的探讨

目的 探讨体温变化与急性脑梗死的临床关系及其机制。方法 根据入院时体温将306例入院确诊急性脑梗死患分为体温正常组(≤37．5℃)和体温升高组(＞37．5℃)，分析体温变化与神经功能抉损程度、梗死灶大小及病死率之间的关系。结果 体温升高组的神经功能缺损程度、梗死灶大小及病死率与体温正常组比较，具有权显性差异(P＜0．01)，梗死以大灶梗死居多，病死率与入院时体温升高有明显相关性。结论 体温升高加重急性期脑缺血的损害。临床上应采取降温措施，以防急性脑梗死进一步发展。     

高血压脑出血并发消化道出血高危因素分析

目的探讨影响高血压脑出血并发消化道出血的因素并提出预防措施。方法总结１９９１年５月至１９９６年５月间我院收治的２４０例高血压脑出血病人的有关资料，其中发生消化道出血者４１例。采用Ｌｏｇｉｓｔｉｃ回归模型分析各种可能因素对促使高血压脑出血并发消化道出血的作用。结果单因素分析显示：１出血部位，２意识状态，３血肿量，４出血破入脑室，５使用激素这５个因素显示统计学意义。但进入Ｌｏｇｉｓｔｉｃ多变量回归模型的因素只有出血破入脑室。结论出血破入脑室可能是导致消化道出血最危险的因素，尽早减压应是预防消化道出血的重要措施。     

脑出血患者预后的影响因素分析

目的 探讨脑出血患者预后影响因素.方法 将脑出血患者按生存与否分为2组,按统一标准分别整理其预后影响因素,进行非条件Logistic逐步回归分析.结果 最终入选变量是出血部位(χ2=11.565,P=0.001)、入院时意识状态(χ2=7.780,P=0.005)、出血病灶大小(χ2=7.706,P=0.007)、肺部感染(χ2=6.110,P=0.010)、发病至入院时间(χ2=6.296,P=0.012)、年龄(χ2=5.780,P=0.015)、睡眠呼吸暂停综合征(χ2=5.503,P=0.019).结论 经统计学分析,脑出血患者预后的影响因素依次是出血部位、入院时意识状态、出血病灶大小、肺部感染、发病至入院时间、年龄、睡眠呼吸暂停综合征;除年龄和出血部位为不可逆因素外,其他预后影响因素经人为干预可使其在一定程度上发生改变.     

急性脑梗死患者体温与预后关系分析

目前急性脑梗死是神经内科最常见的一组疾病,发病率高、致残率高,给人类健康造成极大的伤害,给家庭和社会带来了沉重的经济负担。体温是重要的生命体征之一,在神经内科临床护理中,体温是我们观测的重点之一。近年来,通过对急性脑梗死患者的体温观测及分析,发现急性脑梗死患者的体温改变和预后有重要相关性,对病人进行体温干预,能明显改善病人预后。     

Influence of admission body temperature on stroke mortality

BACKGROUND AND PURPOSE: The influence of body temperature on stroke outcome remains uncertain. The aim of this study was to investigate the prognostic role of admission body temperature on short-term and long-term mortality in a retrospective cohort study of patients with acute stroke. METHODS: A retrospective cohort of 509 patients with acute stroke, admitted to a tertiary hospital between July 1, 1995, and June 30, 1997, was studied. The relationship between admission body temperature and mortality both in-hospital and at 1-year mortality was evaluated. Body temperature on admission was classified as hypothermia (36.5 degrees C and 37.5 degrees C). Logistic regression and proportional hazards function analysis were performed after adjustment for clinical predictors of stroke outcome. RESULTS: In ischemic stoke, mortality was lower among patients with hypothermia and higher among patients with hyperthermia. The odds ratio for in-hospital mortality in hypothermic versus normothermic patients was 0.1 (95% CI, 0.02 to 0.5). The relative risk for 1-year mortality of hyperthermic versus normothermic patients was 3.4 (95% CI, 1.6 to 7.3). A similar but nonsignificant trend for in-hospital mortality was seen among patients with hemorrhagic stroke. CONCLUSIONS: An association between admission body temperature and stroke mortality was noted independent of clinical variables of stroke severity. Hyperthermia was associated with an increase in 1-year mortality. Hypothermia was associated with a reduction in in-hospital mortality.     

Significance of admission hypoalbuminemia in acute intracerebral hemorrhage

Low levels of serum albumin may increase the risk of infections and mortality in critically ill patients. We tested the hypothesis that admission hypoalbuminemia predicted infectious complications and poor outcome in subjects with acute intracerebral hemorrhage (ICH). We analyzed a single center cohort of ICH patients collected between 1994 and 2015. Pneumonia, urinary tract infection and sepsis were retrospectively identified, according to validated criteria. Serum albumin was measured on admission and hypoalbuminemia was defined as total albumin ≤3.5 g/dL. The association between albumin levels, infections, and mortality at 90 days was tested with multivariable logistic regression analyses. A total of 2010 patients were included (median age 74 years, 54.5% males) of whom 444 (22.1%) had hypoalbuminemia on admission and 763 (38%) died within 90 days. The frequency of pneumonia, urinary tract infection, and sepsis was 19.9, 15.1, and 2.7%, respectively. Hypoalbuminemic patients had lower admission Glasgow coma scale, higher frequency of intraventricular hemorrhage and were more likely to have a history of chronic kidney or liver disease. After adjustment for potential confounders, hypoalbuminemia was an independent predictor of pneumonia [odds ratio (OR) 1.76, 95% confidence interval (CI) 1.34–2.33, p < 0.001] and sepsis (OR 2.29, 95% CI 1.22–4.30, p = 0.010). Low levels of albumin were also independently associated with higher mortality at 90 days (OR 1.78, 95% CI 1.30–2.44, p < 0.001). In conclusion, early hypoalbuminemia is common and predicts poor outcome in ICH patients. Increased susceptibility to pneumonia and sepsis may be the pathophysiological mechanism underlying this association.     

Early mortality following spontaneous intracerebral hemorrhage

The authors reviewed the charts of 1,421 patients with cerebral hemorrhage to determine the cause of death. Limitation or withdrawal of life-sustaining interventions was the most common cause of death (68%) followed by brain death (28%). Neurologic reasons were the most common cause of delayed decisions to withdraw or limit therapy. Brain death was more common in African Americans, whereas life-sustaining interventions were withdrawn or limited early more often in whites.