【摘要】 目的 分析脑中心疝对脑出血患者预后的影响，明确早期判定的重要性。 方法 回顾分析2005年2月－2010年8月所有因脑出血行手术治疗的173例患者的临床资料，其中并发小脑幕切迹疝48例，并发脑中心疝37例。 结果 173例患者治愈97例，轻残25例，中残30例，持续植物状态2例，死亡19例；死亡原因：脑功能衰竭11例，颅内感染2例，肺功能衰竭2例，肾功能衰竭3例，弥散性血管内凝血1例。脑中心疝患者病死率（27.03%）高于非脑中心疝患者（6.62%），差异有统计学意义（χ2=10.393，P=0.001）。脑中心疝分期与GOS分级呈负相关关系（rs=-0.827，P=0.000），分期越早，GOS分级越高；脑中心疝存活的27例患者日常生活、活动分级与脑中心疝分期呈正相关关系（rs=0.630，P=0.000），分期越早，ADL分级越低。 结论 脑中心疝的早期判定可以减少患者并发症的发生，降低病死率及伤残率。
【Abstract】 Objective To Analyze the effect of brain center hernia on the prognosis of cerebral hemorrhage patients, and clarify the importance of early judgment of brain center hernia. Methods The recorded data of 173 patients undergoing surgery for cerebral hemorrhage in our hospital from February 2005 to August 2010 were retrospectively analyzed. Among them, there were 48 cases of combined transtentorial herniation and 37 cases of combined brain center hernia. Results Among the 173 patients, 97 were cured, 25 were slightly disabled, 30 were moderately disabled, 2 were in persistent vegetative state (PVS), and 19 died. In the 19 dead patients, 11 died of brain function failure, 2 of intracranial infection, 2 of lung failure, 3 of renal failure, and 1 of disseminated intravascular coagulation (DIC). The mortality of patients with brain center hernia (27.03%) was significantly higher than that of non-brain center hernia patients (6.62%) (χ2=10.393, P=0.001). The period of brain center hernia was negatively correlated with GOS′s stage (rs=-0.827, P=0.000), and the earlier the period, the higher the GOS stage. The brain center hernia period in the 27 survival patients was positively correlated with their ADL stage (rs=0.630, P=0.000), and the earlier the period, the lower the ADL stage. Conclusion Early judgement of brain center hernia can reduce patients′ complications, their mortality and disability rate.
Citation：
SONG Minghao,LI Zhixiang,MA Wenbing,TANG Zhong,CHEN Jiangsheng,WEN Rui. The Effect of Judgment of Brain Center Hernia on the Prognosis of Cerebral Hemorrhage Patients. West China Medical Journal, 2011, 26(8): 1150-1152. doi:
Copy
Copyright © the editorial department of West China Medical Journal of West China Medical Publisher. All rights reserved
| 1. |
Diringer MN. Intracerebral hemorrhage: pathophysiology and management[J]. Crit Care Med, 1993, 21(10): 1591-1603.
|
| 2. |
Plum DM, Posner MB. The diagnosis of stupor and coma[M]. Philadelphia: F.A. Davis Co., 1966: 44-45.
|
| 3. |
王忠诚. 神经外科学[M]. 北京: 人民卫生出版社, 2008: 284.
|
| 4. |
中华医学会全国第四次脑血管病学术会议. 各类脑血管疾病诊断要点[J]. 中华神经科杂志, 1996, 29(6): 3791.
|
| 5. |
Wagner KR, Xi G, Hua Y, et al. Early metabolic alterations in edematous perihematomal brain regions following experimental intracerebral hemorrhage[J]. J Neurosurg, 1998, 88(6): 1058-1065.
|
| 6. |
邓发斌, 游潮, 李浩. 微创颅内血肿清除术治疗高血压脑出血的预后影响因素分析[J]. 现代预防医学, 2010, 37(13): 2549-2551.
|
| 7. |
蒋海清, 雷剑, 王肇平, 等. CT测量脑中线结构移位预测急性脑疝的临床应用[J]. 中国临床医生杂志, 2007, 35(1): 63-64.
|
| 8. |
杨咏波, 黄玉杰, 游潮, 等. 额叶挫裂伤致脑中心疝31例临床分析[J]. 华西医学, 2007, 22(4): 706-707.
|
| 9. |
张国庆, 叶航, 商建军, 等. 重型创伤性脑损伤并发脑中心疝37例[J]. 中国临床医生杂志, 2009, 37(2): 43-45.
|
| 10. |
刘正敏, 李萍. 高血压脑出血致脑中心疝临床分析[J]. 心脑血管病防治, 2010, 10(1): 46-47.
|
| 11. |
Albanèse J, Leone M, Alliez JR, et al. Decompressive craniectomy for severe traumatic brain injury: evaluation of the effects at one year[J]. Crit Care Med, 2003, 31(10): 2535-2538.
|
| 12. |
司东明, 刘献志. 高血压脑出血外科治疗新进展[J]. 中国实用神经疾病杂志, 2010, 13(1): 77-79.
|
| 13. |
叶沛, 李青国, 王步东, 等. 双侧额颞脑挫裂伤并脑中心疝临床分析[J]. 安徽医药, 2009,13(2): 43-45.
|
| 14. |
宋明浩, 李志祥, 马文斌. 术前快速锥颅引流在治疗脑出血所致脑疝过程中临床应用分析[J]. 中风与神经疾病杂志, 2010, 27(11): 1029.
|
- 1. Diringer MN. Intracerebral hemorrhage: pathophysiology and management[J]. Crit Care Med, 1993, 21(10): 1591-1603.
- 2. Plum DM, Posner MB. The diagnosis of stupor and coma[M]. Philadelphia: F.A. Davis Co., 1966: 44-45.
- 3. 王忠诚. 神经外科学[M]. 北京: 人民卫生出版社, 2008: 284.
- 4. 中华医学会全国第四次脑血管病学术会议. 各类脑血管疾病诊断要点[J]. 中华神经科杂志, 1996, 29(6): 3791.
- 5. Wagner KR, Xi G, Hua Y, et al. Early metabolic alterations in edematous perihematomal brain regions following experimental intracerebral hemorrhage[J]. J Neurosurg, 1998, 88(6): 1058-1065.
- 6. 邓发斌, 游潮, 李浩. 微创颅内血肿清除术治疗高血压脑出血的预后影响因素分析[J]. 现代预防医学, 2010, 37(13): 2549-2551.
- 7. 蒋海清, 雷剑, 王肇平, 等. CT测量脑中线结构移位预测急性脑疝的临床应用[J]. 中国临床医生杂志, 2007, 35(1): 63-64.
- 8. 杨咏波, 黄玉杰, 游潮, 等. 额叶挫裂伤致脑中心疝31例临床分析[J]. 华西医学, 2007, 22(4): 706-707.
- 9. 张国庆, 叶航, 商建军, 等. 重型创伤性脑损伤并发脑中心疝37例[J]. 中国临床医生杂志, 2009, 37(2): 43-45.
- 10. 刘正敏, 李萍. 高血压脑出血致脑中心疝临床分析[J]. 心脑血管病防治, 2010, 10(1): 46-47.
- 11. Albanèse J, Leone M, Alliez JR, et al. Decompressive craniectomy for severe traumatic brain injury: evaluation of the effects at one year[J]. Crit Care Med, 2003, 31(10): 2535-2538.
- 12. 司东明, 刘献志. 高血压脑出血外科治疗新进展[J]. 中国实用神经疾病杂志, 2010, 13(1): 77-79.
- 13. 叶沛, 李青国, 王步东, 等. 双侧额颞脑挫裂伤并脑中心疝临床分析[J]. 安徽医药, 2009,13(2): 43-45.
- 14. 宋明浩, 李志祥, 马文斌. 术前快速锥颅引流在治疗脑出血所致脑疝过程中临床应用分析[J]. 中风与神经疾病杂志, 2010, 27(11): 1029.
