天津医药

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青年高血压脑出血的临床特点分析

贾颖1,田野1,王景华1,江荣才1,张建宁1,2   

  1. 1. 天津医科大学总医院神经外科
    2.
  • 收稿日期:2013-08-27 修回日期:2013-10-30 出版日期:2013-12-15 发布日期:2013-12-15
  • 通讯作者: 贾颖

The clinical characters of the young patients with hypertensive intracerebral hemorrhage

  • Received:2013-08-27 Revised:2013-10-30 Published:2013-12-15 Online:2013-12-15

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摘要：

【摘要】目的  分析青年高血压脑出血的临床特点，为优化其预防及治疗提供参考依据。方法  收集青年高血压脑出血患者55例，比较不同性别、体质量指数（BMI）、发病前高血压控制情况、发病后就诊时间、入院时格拉斯哥昏迷评分（GCS）、出血部位、血肿量及治疗方法的预后情况。  结果  55例青年高血压脑出血患者中预后不良28例（50.9%），死亡12例（21.8%），多见于男性（83.6%）、基底节区血肿（80.0%）、超重肥胖（61.8%）、发病前高血压控制不良者（89.1%）。BMI正常较超重肥胖者（66.67%vs38.24%），发病前高血压控制良好较控制不良者（100.00%vs42.86%），发病后6h内就诊较6h后就诊者（61.76%vs28.57%），GCS为9～12分、13～15分较3～8分者（75.00%vs78.95vs12.50%），单纯基底节区血肿较基底节区血肿破入脑室者（60.61%vs18.18%），基底节区血肿量≤40mL者
较＞40mL者（73.68%vs32.00%）的预后良好率高（均P＜0.05）。基底节区血肿量20～40mL者中，手术治疗较保守治疗者的预后好（100.00%vs28.57%，P＜0.05）。  结论  控制体质量与血压、早期就诊及适当放宽手术指征等是改善青年高血压脑出血患者预后的重要措施。

关键词: 颅内出血, 高血压性, 预后, 脑血管基底神经节出血, 血肿, 青年, 临床

Abstract: Abstract Objective The clinical characters of young patients suffering from the hypertensive intracerebral hemorrhage retained to be well understood. In order to further inspect the disease and improve its diagnosis and treatment, the data of these kind of patients in our center were collected and analyzed. Methods The clinical data of 55 young patients(≤44years) with hypertensive intracerebral hemorrhage in our center were enrolled from the Feb. of 2007 to Feb. of 2013. The MRS（Multiple Rankin Scale）was applied to evaluate their prognosis. The GCS scores at admitting, body mass index(BMI),the status of the hypertension controlling before administration, the interval term between the stroke and the administration in hospital, the location of the cerebral hemorrhage and the volume of the hematomas were all analyzed to assay their correlation with the prognosis. Results The majority of the sufferers were male. The hemorrhage most appeared in the basal ganglia. The patients with hematoma in basal ganglia and bleeding in the ventricles had worse prognosis than other ones with hematomas in other locations. Furthermore, the bad prognosis appeared in the patients with low admitting GCS, huge hemorrhage volumes, overweight and lately administration after stroke. The patients were mostly died with moderate hemorrhage in early stage because of their primary diseases. The prognosis of all the surgical treating patients with the modulate size of hematomas was good. Conclusion: Controlling the blood pressure, losing the weight, receiving conserve or surgical therapy in the early phase and expanding the surgical criteria are all the important strategies to improve the prognosis of the young patients with hypertensive intracerebral hemorrhage.