41例原发性脑室出血临床特点及预后因素分析  

Analysis of clinical features and prognostic factors of 41 cases of primary intraventricular hemorrhage

作　　者：周格知[1] 杨帆[1] 童民锋[1] 袁坚列[1] ZHOU Ge-zhi;YANG Fan;TONG Min-feng(Department of Neurosurgery,Jiahua Municipal Central Hospital,Jinhua,Zhejiang 321000,China)

机构地区：[1]金华市中心医院神经外科,浙江金华321000

出　　处：《中华全科医学》2018年第11期1804-1806,1923,共4页Chinese Journal of General Practice

基　　金：浙江省科技计划项目(2013C33103)

摘　　要：目的探讨原发性脑室出血(PIVH)的临床特点及与预后相关因素。方法回顾性研究2011年1月—2016年1月收住在金华市中心医院的PIVH患者资料,包括人口学资料、基础疾病、影像学资料、预后等,分析PIVH病因、临床特点及与预后相关的因素。结果共纳入符合标准的PIVH患者41例,占所有脑出血的3. 8%,其中男性25例(61. 0%),年龄(50. 1±12. 3)岁。最常见基础疾病为高血压病20例(48. 8%),最常见初始症状为头痛25例(61. 0%)。根据出血原因,分为特发性组24例(58. 5%)和脑血管病组17例(41. 5%)。特发性组年龄、高血压比例、GCS评分较脑血管病组高,而Graeb评分低,差异有统计学意义(P <0. 05)。随访6个月,根据改良Rankin评分(mRS),分为预后良好组(mRS:0～2分)25例(61. 0%),预后不良组(mRS:3～6分)16例(39. 0%)。预后不良组较预后良好组入院时Graeb评分高、GCS评分低、急性脑积水发生率高,差异均有统计学意义(均P <0. 05),特发性组预后好于脑血管病组(P <0. 05)。结论 PIVH发病率低,预后差,建议脑血管造影明确出血原因。入院时Graeb评分高、GCS评分低、合并急性脑积水及脑血管病性出血的PIVH患者预后较差。Objective To investigate the clinical characteristics and prognostic factors of primary intraventricular hemorrhage （PIVH）. Methods A retrospective study was conducted. The data of PIVH patients in Jinhua Municipal Central Hospital from January, 2011 to January, 2016, including demography, medical history, radiological imaging and prognosis, was collected to evaluate the etiological causes, clinical features and prognostic factors. Results A total of 41 patients with PIVH were enrolled in the study finally, which account for 3.8% of patients with hemorrhagic stroke. In all 41 patients, 61.0% were male （25 cases） and the mean patient age was （50.1 ± 12.3） years. Hypertension was the most common medical history （20 cases, 8.8% ） and headache was the most common initial symptom （25 cases, 61.0% ）. According to cause of hemorrhage, patients were divided into idiopathic group （24cases, 58.5% ） and vascular structural abnormality （VSA）-related group （17 cases, 41.5% ）. Age, proportion of hypertension and GCS in the idiopathic group were all significantly higher than those in VSA-related group （ P 〈 0.05 ）. According to the modified Rankin scale （mRS）, 25 cases （61.0%） have favorable outcome （mRS：0 -2） and 16 cases （39.0%） have unfavorable outcome （mRS：3 -6） during the 6-month follow-up. The unfavorable outcome group have significantly higher Graeb score and proportion of acute hydrocephalus, and lower GCS than favorable outcome group （ P 〈 0.05 ）. The idiopathic group has better outcome than VSA-related group （ P 〈 0.05 ）. Conclusion PIVH is a rare type of hemorrhagic stroke with a poor outcome. We recommend routine cerebral angiography to identify etiological cause. High Graeb score, low GCS, acute hydrocephalus and VSA-related PIVH are associated with poor prognosis.

关 键 词：原发性脑室出血 病因 临床特点 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]