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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 assess the clinical, laboratory, and imaging factors that affect the early prognosis of patients with supratentorial ICH. Methods The levels of serum neuron specific enolase (NSE) on the first, second, third, fourth, seventh and fourteenth days of onset of spontaneous supratentorial bleeding were detected by EL-ISA. The volume of intracerebral hematoma was calculated, the ventricular hemorrhage score, midline shift, Glasgow coma score (GCS) at admission and duration of illness were recorded, and the Glasgow prognostic score (GOS) at 30 d was recorded. Blood pressure, blood glucose and peripheral blood leukocytes (WBC) were measured at admission. Results The poor prognosis group had significantly increased peak NSE, blood glucose and blood pressure, peripheral blood WBC number and larger brain parenchyma or ventricular hemorrhage, significantly decreased GCS (P <0. 05), which admission GCS and The NSE peak is an independent predictor. NSE dynamic curve in the incidence of sudden increase in 2-4 48h indicates the death. All patients with NSE> 25 ng / ml during the course of the disease died. Conclusion The above indexes are all important predictors of early prognosis of cerebral hemorrhage.