老年人高血压脑出血患者继续出血134例分析

目的探讨老年人高血压脑出血患者继续出血的发生率、发生时间及相关因素与预后关系。方法对134例老年人高血压脑出血患者的动态头颅CT检查结果进行分析,对首次CT检查时间、血肿部位、血肿量及病程中的血压变化、发病前是否伴有糖尿病史和癫痫发作史进行对比分析。结果 134例老年人高血压脑出血有继续出血42例,发生率31.3%,其中27例(64.3%)发生于发病后24 h以内,10例(23.8%)发生于24~72 h,3例(7.1%)发生于72～168 h,2例(4.7%)发生于168 h以后;血肿量21～30 ml者继续出血的发生率最高,脑叶血肿及血肿破入脑室者易继续出血;病程中有持续性高血压、癫痫发作及发病前有糖尿病史者继续出血的发生率较高。结论老年人高血压脑出血患者近1/3有继续出血发生;首次CT检查时间在24 h内,尤其是血肿量为21～30 ml和脑叶出血者,继续出血的发生率较高;病程中有持续性高血压,伴有糖尿病史及癫痫发作史与继续出血密切相关。有继续出血及有相关并发症时预后不良。

Analysis of continuous hemorrhage after hypertensive cerebral hemorrhage in 134 elderly cases

Objective To explore the incidence rate,the occurrence time and the related factors and their relationship with prognosis in continuous hemorrhage after elderly hypertensive cerebral hemorrhage.Methods The dynamic cranial CT examination results of 134 elderly patients with hypertensive cerebral hemorrhage were analyzed.The time of the first CT examination,hematoma location,hematoma volume and blood pressure changes during disease course,diabetes history and seizure history before the onset were performed the comparative analysis.Results Of 134 elderly patients,42 had the symptoms of continuous hemorrhage with the incidence rate of 31.3%.And it occurred within 24 h after onset in 27 cases(64.3%),10 cases in 24-72 h(23.8%),3 cases(7.1%) in 72-168 h and 2 cases(4.7%) 168 h later.The patients with hematoma volume of 21-30 ml had the highest incidence of continuous hemorrhage,and the ones with lobar hematomas and hematomas broken into ventricles easily had continuous hemorrhage.The patients with persistent high blood pressure and seizures in the disease course or a diabetes history before onset had a higher incidence.Conclusion Nearly 1/3 elderly patients with hypertensive cerebral hemorrhage have continuous hemorrhage.If the first CT examination is within 24 h,in particular,those with the hematoma volume of 21-30 ml or lobar hemorrhage,the incidence of continuous hemorrhage is higher.Persistent high blood pressure in the disease course,diabetes history and epileptic seizures history before onset of hypertensive cerebral hemorrhage have a close relation to continuous hemorrhage.