复发性脑出血的临床特征及预后分析  

Analysis of clinical features and prognosis of recurrent cerebral hemorrhage

作　　者：祁占宁[1] 刘文[1] 刘永宏[1] 胡新永[1] 张东亚[1] 来海欧[1] 姬利[1] 马海[1] 夏辉[1] 殷成龙[1] 薛常虎 王飒[1] 戴太铖[1] 

机构地区：[1]延安大学咸阳医院神经内科,陕西咸阳712000 [2]咸阳市中心医院,陕西咸阳712000

出　　处：《西部医学》2016年第12期1684-1689,共6页Medical Journal of West China

基　　金：陕西省科学技术研究计划项目(2011K12-28);咸阳市科学技术研究计划项目(2009XK0914)

摘　　要：目的研究复发性脑出血的临床特征及预后，并提出相应的预防措施。方法对2010年1月～2013年10月住院治疗的复发性脑出血患者的危险因素、复发间隔时间、服药情况等资料进行分析，并对幸存患者进行电话随访。结果调查脑出血患者共1800例，其中复发性脑出血患者367例，有高血压病痛史201例；第1次出血到第2次出血时间以1年内复发率最高；复发时间最短1个月，最长达20年。再出血发生于对侧200例，同侧74例，病人未规律服药是诱发再出血的重要因素之一，服用抗血小板聚集药物后脑出血的复发率及死亡率比未服用抗血小板聚集药物的患者明显升高（P〈0．05）。电话随访复发性脑出血367例，其中有67例因电话停机、空号等因素不能接通，12例接通后拒绝进一步回答并挂断电话，12例诉“电话打错了”。其余274例患者，经电话随访得知已有50例去世，45例日常生活不能自理，130例生活可自理，49例不详。结论复发性脑出血病灶大多在首发病灶的对侧，病死率、致残率高，且再发与高血压关系密切，任何可能引起血压剧烈波动的原因都可能导致脑出血的再发，因此控制血压是防止复发性脑出血发生的关键，而提高患者的服药依从性至关重要，服用抗血小板聚集药物的获益与风险仍待进一步研究与探索。大多数患者生活态度乐观并坚持康复锻炼，肢体功能恢复良好，有一部分患者因再次出血后出现抑郁等不良情绪，对其终点事件（死亡）起到了推动作用；主要死因为脑疝形成、上消化道出血、肺部感染及心力衰竭。Objective To study the clinical features and prognosis of recurrent cerebral hemorrhage, and corresponding prevention measures were put forward. Methods Risk factors, recurrence interval, drug taking and other data of patients with recurrent cerebral hemorrhage hospitalized from January of 2010 to October of 2013 were analyzed, and the surviving patients were followed up by telephone. Results 1800 patients with cerebral hemorrhage were investigated, 367 and cases were recurrent cerebral hemorrhage. There were 201 cases with history of hypertension. The highest recurrent rate of bleeding in the brain for the first time and the second time cerebral hemorrhage occurred in one year time. One month was the shortest recurrent time, and the longest recurrent time was up to 20 years. There were 200 cases of recurrent cerebral hemorrhage that occurred on the same side, and 74 cases occurred on the other side. One of the important factors that induce recurrent hemorrhage was the non regular medication of patients. The cerebral hemorrhage recurrence and mortality rate of taking antiplatelet aggregation drugs was higher than patients who were not taking antiplatelet aggregation drugs（P〈0. 05）. Phone follow-up, the recurrence of cerebral hemorrhage in 367 cases, of which 67 people because telephone downtime, spacing and other factors cannot be connected, 12 cases after connect refused further answer and hang up the phone, 12 cases were called ＂wrong number＂. 274 cases in the remaining patients, through telephone follow-up that has 50 cases died, 45 patients, often the life cannot provide for oneself, 130 cases of life can provide for oneself, 49 cases is unknown. Conclusion Recurrent cerebral hemorrhage occurs mainly in the lesions of the contralateral, which has high mortality and morbidity. In addition, relapse is closely associated with high blood pressure. All the causes of sharp fluctuations in blood pressure can lead to cerebral hemorrhage relapse, control of blood pressure is the key to the prevention of recu

关 键 词：复发性脑出血 危险因素 临床分析 

分 类 号：R743.34[医药卫生—神经病学与精神病学]