高血压脑出血合并二次脑创伤因素的探讨

目的：观察二次脑损伤（SBI）因素对高血压脑出血（HICH）预后的影响。方法：采用前瞻性方法，总结112例手术治疗的HICH患者的SBI因素，包括平均动脉压（MAP）、颅内压（ICP）、脑灌注压（CPP）、体温（BT）及动脉氧饱和度（SaO2)，分析其与预后的关系。结果：67例（60％）患者合并有SBI，按Glasgow预后评分（GOS），良好14例（21％）、中残19例（28％）、重残24例（36％）、植物生存4例（6％）、死亡6例（9％）；无SBI者45例（40％），恢复良好16例（36％）、中残20例（44％）、重残5例（12％）、植物生存2例（4％）、死亡2例（4％）。结论：多数HICH患者不同程度的存在SBI，合并有MAP，ICP，CPP，BT和SaO2异常等SBI因素者预后不良。

Research of secondary insults and the prognosis of patients with hypertensive intracerebral hemorrhage

AIM To observe the effects of secondary insults in patients with hypertensive intracerebral hemorrhage (HICH).METHODS Prospective study of 112 cases with HICH treated by surgery was conducted to sum up the factors of secondary insults and to analyze their relation and the prognosis. The factors included blood pressure (MAP), intracranial pressure (ICP), cerebral perfusion pressure (CPP), body temperature (BT), saturation of artery oxygen (SaO2) and postoperative complication. RESULTS 67 patients (60%) were complicated with secondary brain injury (SBI). Among them, according to the Glasgow outcome scale (GOS), 14 patients (21%) had good recovery, 19 patients (28%) had moderate disability, 24 patients (36%) had severe disability, 4 patients (6%) were in persistent vegetative state and 6 patients (9%) died. Among the other 45 cases (40%) without SBI,16 patients (36%) had good recovery, 20 patients (44%) had moderate disability, 5 patients (12%) had severe disability, 2 patients (4%) were in persistent vegetative state and 2 (4%) died. CONCLUSION Most patients with HICH, to some degree, have SBI and the patients complicated with secondary injury have a bad prognosis.