血清皮质醇与自发性基底核脑出血破入脑室患者病情及预后的关系

目的：研究血清皮质醇与自发性基底核脑出血破入脑室患者病情及预后的关系。方法选择2011年11月至2015年5月期间因自发性基底核脑出血破入脑室入住我院治疗的患者68例，于患者发病后第1天、第2天、第3天、第5天、第7天和第14天进行血清皮质醇测定，参考患者发病首日血清皮质醇浓度，将患者分为三组，上升组33例，正常组24例，下降组11例。观察并记录患者血肿、肺部感染发病率、住院时间及Graeb评分，并在患者入院和出院3个月时进行格拉斯哥昏迷量表(GCS)评分。结果各组患者不同时间点血清皮质醇水平比较，差异均有统计学意义(P<0.05)，同期各组两两比较差异均有统计学意义(P<0.05)；三组患者入院时血肿、GCS评分、Graeb评分比较差异均有统计学意义(P<0.05)；血清皮质醇下降组血肿(72.6±13.6) mL]和Graeb评分(10.5±1.6)分]均高于升高组(63.4±12.3) mL、(8.7±1.4)分]和正常组(48.3±11.5) mL、(7.4±1.4)分]，而GCS评分(5.6±1.4)分]低于升高组(7.8±1.2)分]和正常组(10.3±1.3)分]，差异均有统计学意义(P<0.05)；升高组患者血肿和Graeb评分高于正常组，而GCS评分低于正常组，差异均有统计学意义(P<0.05)；三组患者出院后3个月GCS评分、住院时间、肺感染发生率比较差异均有统计学意义(P<0.05)；血清皮质醇下降组患者GCS评分(2.8±1.1)分]均低于升高组(3.8±1.2)分]和正常组(3.7±1.1)分]，住院时间(33.7±4.4)d]、肺部感染发病率(51.52%)均高于升高组(22.9±4.4) d、27.27%]和正常组(20.5±5.5) d、20.83%]，差异均有统计学意义(P<0.05)。结论自发性基底核脑出血破入脑室患者血清皮质醇水平与患者病情发展变化关系密切，若患者皮质醇水平降低，则预示患者预后较差。

Study on the relationship between serum cortisol and disease condition,prognosis of patients with spontaneous basal ganglia hemorrhage ruptured into ventricle

Objective To study the relationship between serum cortisol and disease condition, prognosis of pa-tients with spontaneous basal ganglia hemorrhage ruptured into ventricle. Methods A total of 68 cases of patients with spontaneous cerebral hemorrhage of the basal ganglia, who admitted to our hospital from November 2011 to May 2015, were enrolled into this study. The serum cortisol of these patients were determined after 1 d, 2 d, 3 d, 5 d, 7 d and 14 d af-ter onset. With the serum cortisol concentration at the first day as the reference, the patients were divided into three groups:rising group (n=33), normal group (n=24), decreased group (n=11). The hematoma size, incidence of pulmonary infection, length of stay and Graeb score were recorded, and Glasgow Coma Scale (GCS) score at admission and three months after discharge were observed. Results There were significant differences in the serum cortisol concentrations of each group of the three groups at different time points (P<0.05). There were significant differences in the serum cor-tisol concentrations of each two groups of the three groups at same time points (P<0.05). The differences among three groups for hematoma size, GCS score, Graeb score were statistically significant (all P<0.05); Hematoma size and Graeb score (72.6 ± 13.6) mL, (10.5 ± 1.6) points] in decreased group were significantly higher than those in rising group (63.4±12.3) mL, (8.7±1.4) points] and normal group (48.3±11.5) mL, (7.4±1.4) points]. However, GCS score (5.6±1.4) points] was significantly lower than rising group (7.8±1.2) points] and normal group (10.3±1.3) points] (all P<0.05). The bleeding and Graeb score in the rising group were significantly higher than those in the normal group (P<0.05), but GCS score was significantly lower than that in the normal group (P<0.05). There were significant differences among the three groups in the GCS score of 3 months after discharge, length of hospital stay, the incidence of pulmonary infection (P<0.05);The GCS score (2.8±1.1) points] in decreased group were significantly lower than that in the rising group (3.8±1.2) points] and normal group (3.7±1.1) points], but the length of stay (33.7±4.4) d], incidence of pulmo-nary infection (51.52%) were significantly higher than the rising group (22.9±4.4) d, 27.27%, respectively] and the nor-mal group (20.5 ± 5.5) d, 20.83%] (P<0.05). Conclusion Serum cortisol levels closely relate with the illness develop-ment in patients with spontaneous basal ganglia hemorrhage ruptured into ventricle. When the cortisol level decreases, it indicates that the patient has a poor prognosis.