脑中心疝的早期判定对脑出血患者预后的影响

【】　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　ToAnalyzetheeffectofbraincenterherniaontheprognosisofcerebralhemorrhagepatients,andclarifytheimportanceofearlyjudgmentofbraincenterhernia.　Methods　Therecordeddataof173patientsundergoingsurgeryforcerebralhemorrhageinourhospitalfromFebruary2005toAugust2010wereretrospectivelyanalyzed.Amongthem,therewere48casesofcombinedtranstentorialherniationand37casesofcombinedbraincenterhernia.　Results　Amongthe173patients,97werecured,25wereslightlydisabled,30weremoderatelydisabled,2wereinpersistentvegetativestate(PVS),and19died.Inthe19deadpatients,11diedofbrainfunctionfailure,2ofintracranialinfection,2oflungfailure,3ofrenalfailure,and1ofdisseminatedintravascularcoagulation(DIC).Themortalityofpatientswithbraincenterhernia(27.03%)wassignificantlyhigherthanthatofnon-braincenterherniapatients(6.62%)(χ2=10.393,P=0.001).TheperiodofbraincenterherniawasnegativelycorrelatedwithGOS′sstage(rs=-0.827,P=0.000),andtheearliertheperiod,thehighertheGOSstage.Thebraincenterherniaperiodinthe27survivalpatientswaspositivelycorrelatedwiththeirADLstage(rs=0.630,P=0.000),andtheearliertheperiod,thelowertheADLstage.　Conclusion　Earlyjudgementofbraincenterherniacanreducepatients′complications,theirmortalityanddisabilityrate.