摘要：

目的 总结自发性多部位脑出血（MICH）的临床特征。方法 分别采取保守治疗、穿刺引流血肿清除术、血肿清除术和（或）去骨瓣减压术治疗30 例自发性多部位脑出血和600 例单一部位脑出血（SICH）患者；采用改良Rankin 量表评价发病后3 个月预后。结果 与SICH 组相比，MICH 组患者高血压> 5 年（P = 0.008）、糖尿病（P = 0.024）、高胆固醇血症（P = 0.050）和缺血性卒中（P = 0.026）发生率均较高，发病后平均动脉压升高（P = 0.002）且多伴有肢体活动障碍（P = 0.000），基底节和丘脑为出血好发部位（P = 0.001）。随访至发病后3 个月，MICH 组患者预后不良（P = 0.006）。结论 高血压> 5 年、糖尿病、高胆固醇血症和缺血性卒中是诱发多部位脑出血的病理生理学基础，患者临床症状严重、远期生活质量差。

关键词: 脑出血, 高血压, 神经外科手术

Abstract:

Objective To analyze the clinical features of multiple spontaneous intracerebral hemorrhages (MICH). Methods Conservative therapy, puncture and drainage, hematoma removal and/or decompressive craniectomy were used in the treatment of 630 intracerebral hemorrhage (ICH) patients, who were divided into 2 groups: 30 cases with MICH and another 600 cases with solitary intracerebral hemorrhage (SICH). Three months after onset, modified Rankin Scale (mRS) was used to evaluate the prognosis of all cases. Results Compared with patients in SICH group, the occurrence rate of hypertension > 5 years (P = 0.008), diabetes mellitus (P = 0.024), hypercholesterolemia (P = 0.050) and previous ischemic stroke (P = 0.026) were all significantly higher in MICH group. The mean arterial pressure (MAP) level (P = 0.002) and the incidence of limb movement disorder (P = 0.000) were significantly higher in patients with MICH than those with SICH. Basal ganglia and thalamus were the predilection sites of hematoma (P = 0.001). Patients with MICH had worse prognosis compared to those with SICH 3 months after onset (P = 0.006). Conclusions Hypertension > 5 years, diabetes mellitus, hypercholesterolemia and ischemic stroke were identified to be the pathophysiological basis of MICH in this study. All patients with MICH had more serious clinical manifestations after onset and worse prognosis.

Key words: Cerebral hemorrhage, Hypertension, Neurosurgical procedures