摘要
目的探讨前循环大面积脑梗死(MCI)的临床特征及影响预后的高危因素。方法回顾性分析90例MCI患者临床资料,发病后1个月内死亡者纳入死亡组(n=26),未死亡者纳入存活组(n=64)。归纳MCI总体临床特征,分析影响预后的高危因素。结果 MCI多由高血压性脑动脉硬化及心源性脑栓塞所致,患者多存在头痛、呕吐、尿失禁、昏迷、中枢性高热等体征,部分还可伴发肺部感染或消化道出血,且存在不同程度的躯干、肢体感觉障碍,可伴有双眼偏向梗死灶侧凝视症状;发病后1个月内死亡率为28. 89%,死因为脑疝或多器官衰竭,存活患者后遗症严重,多以植物生存与不同程度瘫痪为主。高龄、脑室中线移位较大、继发肺部感染及单纯保守治疗是导致MCI患者死亡的独立危险因素(P <0. 05)。结论 MCI临床特征突出且病死率较高,故针对高龄、脑室中线较大移位、继发肺部感染及单纯采取保守治疗的患者需引起足够重视,以期最大程度改善其预后。
Objective To explore the clinical features of massive cerebral infarction( MCI) and the high-risk factors for prognosis.Methods The clinical data of 90 patients with MCI were retrospectively analyzed.The patients who died within 1 month after onset were included in death group( n = 26),and the patients who were survival were included in survival group( n = 64).The overall clinical features of MCI were summarized to analyze the high risk factors for prognosis of the patients.Results MCI was mostly caused by hypertensive cerebral arteriosclerosis and cardiogenic cerebral embolism. The patients were often with the signs of headache,vomiting,urinary incontinence,coma and central hyperpyrexia.Some patients might also be associated with pulmonary infection or gastrointestinal bleeding with different degrees of sensory disability of trunk and limbs,and they might be accompanied by staring symptoms on the lesion side of bilateral eyes.The mortality rate within 1 month after onset was 28. 89% due to cerebral palsy or multiple organ failure.Severe sequelae in survivors mostly included vegetable survival and different degrees of paralysis.Non-conditional logistic multivariate stepwise regression analysis showed that older age,greater midbrain displacement,secondary pulmonary infection and pure conservative treatment were independent risk factors for death in MCI patients( P < 0. 05).Conclusion MCI has prominent clinical features and high mortality rate.Therefore,patients with older age,greater midbrain displacement,secondary pulmonary infections and pure conservative treatment should be given adequate attention in order to maximize the prognosis.
引文
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