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1、中华医学杂志2003年3月25日第83卷第6期 NatlMedJChina,March25,2003,Vol83,No.6·467··论著·基底节内囊区出血的分型及预后的研究牛松涛 张在强 张星虎 高培毅【摘要】 目的 探讨基底节内囊区血肿发生部位、责任血管与临床症状、体征、影像学特点及临床预后之间的相互关系。方法 依据患者影像中原发出血灶的部位与责任血管将基底节内囊区出血分为6个亚型:(1)前部型;(2)中间型;(3)后中间型;(4)后外侧型;(5)外侧型;(6)大量出血型。通过改良Rankin量表(
2、MRS)评价患者病初临床表现及近期预后。结果 前部型占12115%,68118%患者MRS=0～2分,1例死亡。中间型出血占6163%,50%患者MRS=5分,没有死亡病例。后中间型占10150%,52163%患者MRS=0～2分,没有死亡病例。后外侧型出血占18178%,76147%患者MRS=5分,17165%患者死亡。外侧型出血最为常见(39123%),38103%患者MRS=5分,8145%患者死亡。大量出血型发病率亦较高(12171%),47182%患者MRS=5分,47183%患者死亡。结论
3、 血肿的位置及所侵犯的临近区域是影响纹状体内囊出血预后的决定要素,六型分类法为预测临床预后和指导治疗提供了简易可靠手段。【关键词】 脑出血; 分型; 预后Typingandprognosisofstriatocapsularhemorrhage,studyof181casesNIUSong2tao,ZHANGZai2qiang,ZHANGXing2hu,GAOPei2yi1DepartmentofNeurology,TiantanHospital,Beijing100050,China【Abstract
4、】ObjectiveToanalyzetheimpactofhematomalocationandvascularterritoryontheclinicalsymptomsandsigns,neuroimagingfindings,andclinicalprognosisofstriatocapsularhemorrhage1MethodsThedataof181casesofstriatocapsularhemorrhage,124malesand57females,aged28～89,includ
5、ingmedicalhistory,symptoms,andsignswereanalyzed1Onthebasisofhematomalocationsandarterialterritories,thestriatocapsularhemorrhagewasdividedintosixtypes:anteriortype(withthebloodsupplyfromHeubner′sartery),middletype(withthebloodsupplyfrommediallenticulostr
6、iateartery),posteromedialtype(withthebloodsupplyfromanteriorchoroidalartery),posterolateraltype(withthebloodsupplyfromposteromedialbranchesoflaterallenticulostriateartery),lateraltype(withthebloodsupplyfromthemostoflateralbranchesoflenticulostriateartery
7、),andmassivetype(withthehematomaoccupyingthewholeorgreaterpartofstriatocapsularregion)1Theshort2termclinicaloutcomeandprognosiswereevaluatedbyModifiedRankinScale(MRS)1Therelationshipbetweenthetypeandoutcomewasanalyzed1ResultsTherewere22casesofanteriortyp
8、e,accountingfor12115%,ofwhich68118%showedanexcellentoutcome(MRS=0～2)andonly1casedied1Therewere12casesofmiddletype,accountingfor6163%,ofwhich6cases(50%)showedapooroutcome(MRS=5)butwithoutdeadcase1Therewere19casesofposterome
