幕上自发性脑出血患者早期预后影响因素的评估  

Evaluation of predictors of short-term outcome in patients with spontaneous supratentorial intracerebral hemorrhage

作　　者：王中原[1] 陈光辉[1] 高志强[1] 周国庆[1] 冯根宝[2] 

机构地区：[1]南京军区南京总医院神经内科,江苏南京210002 [2]南京军区南京总医院内科实验室,江苏南京210002

出　　处：《中风与神经疾病杂志》2000年第2期101-103,共3页Journal of Apoplexy and Nervous Diseases

摘　　要：目的　评估影响幕上自发性脑出血患者早期预后的临床、实验室和影像学因素。方法　采用 EL ISA法检测 5 4例自发性幕上出血患者发病第 1、2、3、4、7、14d的血清神经元特异性烯醇化酶 (NSE)水平。计算脑实质内血肿体积 ,记录脑室出血积分、中线移位、入院时及病程中 Glasgow昏迷评分 (GCS)、发病 30 d时 Glasgow预后评分 (GOS)。检测入院时血压、血糖和周围血白细胞 (WBC)数。结果　预后恶劣组具有显著升高的 NSE峰值、血糖及血压水平、周围血 WBC数和较大的脑实质或脑室出血量、明显降低的 GCS(P<0 .0 5 ) ,其中入院时 GCS及 NSE峰值为独立预测因素。 NSE动态曲线在发病 2 4～ 48h的骤升预示死亡。病程中 NSE>2 5 ng/ ml的患者全部死亡。结论　上述指标均是脑出血早期预后的重要预测因素。Objective To investigate the relationship between outcome and some clinical,laboratory and neuroradiology parameters in patients with spontaneous supratentorial intracerebral hemorrhage. Method Serum neuron specific enolase (NSE) concentraions were examined on days 1,2,3,4,7,and 14 after ictus in 54 patients with spontaneous supratentorial intracerebral hemorrhage by ELISA. Serial glasgow coma scale (GCS) was estimated at and after admission. We also determined the volume of parechymal hemorrhage,secondary intraventricular hemorrhage score,midline shift,blood pressure,blood glucose,and paeripheral WBC counts when the patients were admitted. Clinical outcome was assessed at 30 days after onset with the Glasgow outcome scale(GOS). Result Worse clinical outcome was correlated well with higher peak level of NSE,higher level of blood pressure,blood glucose,peripheral WBC counts,larger hematoma size or intraventricular hemorrhage score,lower GCS on admission,and the presence of midline shift (P<0.05). Multivariate analysis revealed that GCS on admission and peak level of NSE were independent predictors.None of patients with NSE level above 25ng/ml survived. A sudden increased serum NSE concentration indicated an unfavorable outcome. Conclusion All evaluated parameters can predict the short term neurological outcome objectively and reliably.

关 键 词：幕上自发性脑出血 预后 GLASGOW昏迷评分 

分 类 号：R743.34[医药卫生—神经病学与精神病学]