原发性脑干出血的临床分析探讨

目的分析原发性单纯性脑干出血的病因、诊断、治疗、预后及预防。方法回顾性分析原发性单纯性脑干出血的临床资料。结果本组高发年龄50～67岁，既往有高血压病史28例（66．67％），发病时血压升高33例（78．57％）；在脑干出血及中桥脑出血最多见（76．19％）；出血量〈2ml的临床表现不典型，预后佳（治愈率100％）；出血量在2—5ml临床表现典型，病死率低（22．22％），预后良好；出血量5～10ml的预后差，病死率高（77．78％）；出血量〉10ml病死率极高（100％）。结论原发性单纯性脑干出血发病急、病情重、病死率高、预后差；高血压动脉硬化为本病的主要发病原因；CT是原发性单纯性脑干出血的安全、可靠诊断方法；早期行气管切开及亚低温治疗能有效提高疗效及降低死残率；严格控制血压是预防原发性单纯性脑干出血的重要措施。出血部位、出血量大小以及脑干功能受损程度及全身器官功能状态是判断预后的关键。

Clinical analysis of 42 cases of primary brainstem hemorrhage

Objective To analyse the cause, diagnosis,treatment, prognosis and prevention of primary simple brainstem hemorrhage. Methods The clinical data of 42 patients with primary simple brainstem hemorrhage were retrospectively analysed. Results The ages of high incidence ranged from 50 to 67 years;28 cases had history of of hypertension. There were 33 cases of elevated blood pressure （78.57%） at onset of the diseases. Pontine hemorrhage was the most common in brainstem hemorrhage（76. 19% ）. When amount of bleeding was less than 2 ml,the clinical manifestations was atypical, with best prognosis （cure rate 100% ） ;when amount of bleeding ranged between 2 ml and 5 ml, the clinical manifestations was typical, and the fatality rate was lower （22. 22% ）, with good prognosis;when amount of bleeding ranged between 5 ml and 10ml,the fatality rate was high （77.78%） ,with poor prognosis;the fatality rate was highest（ 100% ） when amount of bleeding was more than 10 ml. Conclusion The onset of primary simple hrainstem hemorrhage was acute,with severe disease, the mortality is high, and the prognosis is poor. Hypertension is main etiological cause of the primary simple brainstem hemorrhage. CT is a safe and reliable diagnosis method to primary simple brainstem hemorrhage. As early as possible carries on the tracheotomy and hypothermia treatment can effectively enhance the curative effect and reduce the mortality and the deformity rate. The strict control blood pressure is an important measure that prevents the primary simple brainstem hemorrhage. Bleeding site, bleeding volume, as well as the degree of brain stem dysfunction and the condition of systemic organ function is the key to predicting the prognosis.