42例小脑出血临床分析.docVIP

42例小脑出血临床分析 　　[摘要] 目的 探讨小脑出血的病因、临床表现、治疗方法及临床效果。方法 回顾性总结本科近5年收治的42 例小脑出血的临床资料及治疗方法，并进行综合分析。 结果 小脑出血的主要病因是高血压、动脉硬化；临床表现复杂多样；出血量小于15 mL，采用保守治疗，大于15 mL，采用侧脑室引流加微创小脑血肿清除术；小脑出血血肿量小于5 mL预后良好，大于25 mL预后极差。结论 小脑出血量、有无脑干受压及破入四脑室是决定治疗方法和预后的关键因素。 　　[关键词] 小脑出血；临床特点；治疗方法；预后 　　[中图分类号] R743.34 [文献标识码] A [文章编号] 1674-4721（2012）02（a）-0031-02 　　 　　Clinical analysis of 42 cases of cerebellum hemorrhage 　　LIANG Yun WEI Zhigang ZHOU Liqun LIU Zhenlun 　　Department of Neurology, the Peoples Hospital of Baishan City in Jilin Province, Baishan 134300, China 　　[Abstract] Objective To study the reason, clinical manifestations, treatment methods and clinical effects of hemorrhage in cerebellum. Methods Clinical information and treatment methods of 42 cases of cerebellum hemorrhage treated by us in recent 5 years were retrospectively analyzed. Results The main reasons of cerebellum hemorrhage were hypertension and arteriosclerosis. Clinical features were complex and diverse. When bleeding amounts less than 15 mL, they were given conservative treatment and when bleeding amounts higher than 15 mL, they were treated by lateral ventricle drainage and minimally invasive surgery. Bleeding amounts less than 5 mL had a good prognosis; when higher than 25 mL prognosis was very poor. Conclusion Bleeding amounts, compressing brain stem or not and whether hemorrhage disrupting into the fourth ventricle are key factors of treatment method selection and prognosis judgment. 　　[Key words] Hemorrhage of cerebellum; Clinical features; Treatment methods; Prognosis 　　 　　小脑出血并不少见，约占脑出血的10%[1]。其症状表现多种多样，因出血量不同而有较大差异，并影响其预后及治疗方式的选择。本科2007~2011年共收治小脑出血患者42例，对其临床表现、治疗、预后进行分析，以提高对小脑出血的认识及诊疗水平。 　　1资料与方法 　　1.1一般资料 　　本组男24例，女18例，年龄36~82岁，平均59岁。既往有高血压32例，脑??中史10例，冠心病史5例，糖尿病史6例，高脂血症者19例，脑梗死者5例，脑干出血者1例，顶叶出血者1例，烟酒嗜好20例。平时服用阿司匹林（25~100 mg）者26例。在活动中及精神紧张状态下发病30例，在休息及睡眠中发病的12例。病初误诊为椎基底动脉供血不足的2例，误诊为高血压的1例，误诊为蛛网膜下腔出血的1例。本组均无明显肝肾疾病史。 　　1.2临床表现 　　头痛28例（66.7%），呕吐30例（71.4%），头昏32例（76.2%），意识障碍10例（23.8%），共济失调29例（69.0%），言语障碍1