自发性脑叶出血48例临床剖析.docVIP

自发性脑叶出血48例临床剖析 　　[摘要] 目的:探讨自发性脑叶出血的病因、临床特点、治疗及预后。方法:借助影像学检查,对48例自发性脑叶出血患者进行确诊,并对病因、临床特点、治疗及预后结果进行分类总结。结果:30例无高血压病史,所占比例较大,影像学检查示脑叶出血分团块状、条索状、斑点样出血三类。结论:脑叶出血与非高血压因素关系密切,少量出血保守治疗效果较好,开颅与微创穿刺引流术可降低致死率和致残率。 　　[关键词] 自发性;脑叶出血;影像学检查 　　[中图分类号] R743[文献标识码]A [文章编号]1673-7210(2010)04(a)-049-02 　　 　　Clinical analysis of spontaneous cerebral lobar hemorrhage for 48 patients 　　YANG Kuihua1, WANG Liang2 　　(1.The Eighth Ward, the Second Hospital of Liaoyang City, Liaoyang 111000, China; 2.Department of Neurosurgery, the Fourth Affiliated Hospital of China Medical University, Shenyang 110032, China) 　　[Abstract] Objective: To explore the etiopathogenesis, clinical features, treatment and prognosis of spontaneous cerebral lobar hemorrhage. Methods: With image examination 48 cases of patients were diagnosed. The etiopathogenesis, clinical features, treatment and prognosisresults were retrospectively classified and summarized. Results: 30 cases of patients hadno hypertension history. Taken the most proportion of all. The image showed that cerebral lobe hemorrhage was classified as bolus, trabs and spots hemorrhage. Conclusion: Spontaneous cerebral lobar hemorrhage is highly relative with nonhypertensive factors, expectant treatmenta is better for small quantity of hemorrhage. Craniotomy and minimally puncture are good ways to decrease the disabled and death incidence. 　　[Key words] Spontaneous; Cerebral lobar hemorrhage; Imaging examination 　　 　　自发性脑叶出血是指非创伤性大脑皮质下白质出血,约占非创伤性颅内出血的18%[1]。另有统计,20岁以上的人群中年发病率为8.4/10万,约占全部脑出血的1/3[2]。随着CT的广泛应用,脑叶出血的检出率越来越高,发现其发病率约占各类脑出血的40%[3]。脑叶出血的原因主要有以下几类:高血压性脑叶出血;脑淀粉样变性;脑血管畸形(动静脉畸形破裂出血);动脉瘤破裂出血;脑瘤破裂出血;抗凝或溶栓药物的并发症[4]。本文就2003年5月～2009年5月收住入院治疗的48例脑叶出血患者进行治疗分析。现报道如下: 　　1 资料与方法 　　1.1 一般资料 　　本组48例脑叶出血患者,其中,男30例,女18例;年龄24～88岁,平均(65.5±3.6)岁;病因:既往高血压病史18例,脑淀粉样变性10例,应用抗凝药物史2例,经脑血管造影证实的脑血管畸形5例(其中,动脉畸形4例,静脉畸形1例),动脉瘤6例,脑瘤破裂出血5例,原因未明2例;临床表现:有意识障碍8例,发病过程中有头痛、恶心呕吐39例,有不同程度的肢体瘫痪27例,出现精神症状15例,语言障碍6例(其中,2例表现为懒言,4例失语),癫痫样发作2例,偏盲2例,蛛网膜下腔出血5例。 　　1.2 影像学特点 　　头颅C