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目的 :复习 92例高血压脑出血的临床及影像特征 ,用现代统计方法评估高血压脑出血近期死亡的危险因素。方法 :对患者的年龄、性别、全身疾病史、是否再次出血、出血至入院的间隔时间、脉压差、GCS、出血部位、出血量以及有否瞳孔散大、眼球凝视、肢体瘫痪、失语、中线移位、合并脑室出血、并发消化道出血等进行分析。先采取单因素分析法 ,再用多元逻辑回归法 ,以确定对高血压脑出血近期死亡的最有价值的预计变量。结果 :高血压脑出血的近期病死率为 2 9.3% ,其独立的预计指标为GCS≤ 8分、瞳孔散大、合并消化道出血。采用相同方法进一步分析发现 ,与这些死亡独立预计指标相关的主要因素有脉压差、出血量、有否中线移位。结论 :高血压脑出血近期死亡的可能性主要取决于是否表现出脑干功能受损。早期治疗的中心任务应是避免病情进展至脑干不可逆功能损害。当出现脉压差升高、出血量≥ 6 0ml、中线移位等征象时 ,手术宜不失时机地积极进行。
OBJECTIVE: To review the clinical and imaging features of 92 patients with hypertensive intracerebral hemorrhage and evaluate the risk factors of recent death from hypertensive intracerebral hemorrhage using modern statistical methods. Methods: The patient’s age, gender, history of systemic disease, whether to hemorrhage again, bleeding time to admission, pulse pressure difference, GCS, bleeding site, blood loss and whether mydriasis, eye gaze, limb paralysis, Midline shift, merger ventricular hemorrhage, concurrent gastrointestinal bleeding analysis. Univariate analysis followed by multivariate logistic regression was used to determine the most valuable predictor of recent death from hypertensive intracerebral hemorrhage. Results: The recent mortality rate of hypertensive intracerebral hemorrhage was 2 9.3%. The independent predictive value was GCS ≤ 8 points, with mydriasis and gastrointestinal bleeding. Further analysis using the same method found that the main factors associated with these independent predictors of death were pulse pressure, amount of bleeding, and median shift. CONCLUSIONS: The likelihood of recent death from hypertensive intracerebral hemorrhage depends primarily on whether impaired brainstem function is demonstrated. The central task of early treatment should be to avoid progression to irreversible damage to the brainstem. When the pulse pressure increases, the amount of bleeding ≥ 60ml, midline shift and other signs, surgery should seize the opportunity to actively.