自发性脑室内出血的病因和影响预后因素的分析  

Analysis of the causes of spontaneous intraventricular hemorrhage and the factors influencing prognosis

作　　者：李浩[1] 刘文科[1] 傅敏[1] 王昆[1] 游潮[1] 

机构地区：[1]四川大学华西医院神经外科,成都610041

出　　处：《中国脑血管病杂志》2011年第4期181-184,188,共5页Chinese Journal of Cerebrovascular Diseases

基　　金：卫生公益性行业科研专项项目(200902004)

摘　　要：目的分析自发性脑室内出血的病因、预后及影响预后的因素。方法 2009年1月—2010年1月四川大学华西医院神经外科收治69例自发性脑室内出血患者。所有患者均接受脑血管影像学检察[DSA或CT血管成像(CTA)、MR血管成像(MRA)],分析发病原因。69例患者中行内科保守治疗的有21例,腰椎穿刺持续引流的有9例,钻孔脑室外引流的有8例,开颅手术的有31例。随访4～9个月,采用改良Rankin量表(mRS)评估预后,分析影响预后的因素。结果 69例患者中原发性脑室内出血10例(14.5%),继发性脑室内出血59例(85.5%)。既往有高血压史的65例(94.2%)。①10例原发性脑室内出血患者中,7例行DSA检查,3例行CTA/MRA检查。发现前交通动脉动脉瘤3例(其中1例有高血压史),烟雾病1例,其余6例未见血管异常,但均有高血压史。59例继发性脑室内出血患者均接受CTA/MRA检查,未发现血管异常;其中10例行DSA检查,示小脑血管畸形1例(无高血压史),其余患者均有高血压史。②无手术死亡病例。随访结果显示,mRS评分1～2分患者26例(37.7%),3～4分19例(27.5%),5分11例(15.9%),死亡13例(18.8%)。③不同Graeb评分、GCS评分、脑实质内血肿量、出血部位及是否有梗阻性脑积水的患者预后不同(P<0.05)。结论高血压是脑室内出血的主要原因;根据患者影响预后的临床评估情况制定合理的治疗方案,可以获得比较理想的预后。Objective To analyze the causes, prognosis and the factors influencing prognosis of spontaneous intraventricular hemorrhage. Methods Sixty-nine patients with spontaneous intraventricular hemorrhage were admitted to the Department of Neurosurgery, West China Hospital, Sichuan University from January 2009 to January 2010. All patients received cerebrovascular imaging examinations （ DSA/ CTA/MRA） , and the causes of disease were analyzed. Of the 69 patients, 21 received conservative treat- ments, 9 had lumbar puncture and continuous drainage, 8 had burr holes and ventricular external drainage, and 31 underwent craniotomy. The patents were followed up for 4 to 9 months. The modified Rankin Scale （mRS） was used to assess the prognosis and the factors influencing prognosis were analyzed. Results Of the 69 patients, 10 （ 14.5% ） had primary intraventrieular hemorrhage, and 59 （85.5%） had secondary intraventricular hemorrhage. There were 65 patients（94.2% ） with a past history of hypertension. ①Of the 10 patients with primary intraventricular hemorrhage, 7 underwent DSA, and 3 underwent CTA/MRA examination. Three patients with anterior communicating aneurysm and 1 with moyamoya disease （ 1 of them had a history of hypertension） were found, and no vascular abnormalities were found in the remaining 6 patients, but they all had a history of hypertension. Fifty-nine patients with secondary intraventricular hemorrhage underwent CTA/MRA examination and no vascular abnormalities were found; 10 of them underwent DSA, cerebellar vascular malformation was found in 1 patient （without a history of hypertension）. ②There were no operative mortality occurred. The follow-up results showed that 26 patients （37.7%） had an mRS score ofl-2, 19 （27.5%） had an mRS score of 3-4, 11 （15.9%） had an mRS score of 5, and 13 （ 18.8% ） died. ③The Graeb score, GCS score, volume of parenchymal hematoma, and with or without obstructive hydrocephalus were the factors influencing the prognosis of patients.

关 键 词：脑室内出血 高血压 脑血管障碍 诊断 治疗 

分 类 号：R743.34[医药卫生—神经病学与精神病学]