脑出血的预后

出血性卒中的预后

PROGNOSIS

Mortality and functional outcome ?

脑出血后30天内的死亡率波动在35~52%之间。一半左右的死亡发生于头两天。而且仅仅有一小部分病人在脑出血后能达到生活自理的程度。在一个166例前瞻性的来自大都市脑出血病人的研究中，只有12例病人在30天左右的时候恢复到正常或者轻微残废状态。系统性的回顾分析发现12-39%的病人能达到生活自理。上海东方医院神经外科魏社鹏

 

脑出血后30天内的死亡率波动在35~52%之间。一半左右的死亡发生于出血后前两天。而且仅仅有一小部分病人在脑出血后能达到生活自理的程度。在一个166例前瞻性的来自大都市脑出血病人的研究中，只有12例病人在30天左右的时候恢复到正常或者轻微残废状态。系统性的回顾研究分析后发现，脑出血人群中只有12-39%的病人最终能达到生活自理。

 

脑出血的预后和出血的位置（幕上和幕下），意识水平，病人年龄，总体的医疗健康和条件相关。另外，预先的口服抗凝药物治疗，可能的抗血小板治疗似乎和较差的预后有明显关联。一项研究发现，来自于脑AVM的出血和较低的病死率相关，尽管可能有相似的血肿体积和较高的GCS评分。在一组血管畸形的发现率是91%的自发性脑出血的儿童群体中，死亡率据报道非常低（1/22）。

 

相比于年龄和性别校正后的普通人群而言，原发性脑出血后长期生存的可能性是降低的。一项回顾性的群组研究发现，411位首次脑出血的病人中，相比于对照组，在出血后的第一年，死亡率增加4-5倍，在第二年到第六年，增加2.2倍。继而的纵向的群组研究发现，那些活过前三个月的病人，在后来的7年观察当中，其死亡率显著高于对照组（32.9/19.4）。在一组人群基础的研究当中，例如北肯塔州地区，脑出血后存活的病人中，其十年的生存率是18%。

The 30-day mortality from ICH ranges from 35 to 52 percent [1-8]; one-half of these deaths occur within the first two days [3,7,9]. Furthermore, only a small number of patients function independently after the event. In a prospective study of 166 patients with spontaneous ICH from a large US metropolitan area, only 12 percent were normal or minimally handicapped at 30 days [10]. A systematic review estimated that between 12 and 39 percent of patients achieve independent function [8].

The prognosis after ICH depends upon the location of hemorrhage (supra versus infratentorial location), size of the hematoma, level of consciousness, patient age, and overall medical health and condition [3,4,6,9,11-13]. In addition, preceding oral anticoagulation therapy, and possibly antiplatelet therapy, appears to be associated with worse outcomes after ICH [9,14]. One study found that hemorrhage from a cerebral arteriovenous malformation were associated with a lower case-fatality rate, despite a similar hemorrhage volume and a higher admission Glasgow coma scale compared with spontaneous ICH [15]. Mortality was also reported to be low (1 of 22) in a cohort of children with ICH in whom vascular malformations was the identified etiology in 91 percent [16].

原发性脑出血后长期生存似乎是降低的，相比于年龄和性别校正后的普通人群而言。一项回顾性的群组研究发现，411位病人首次脑出血患者，相比于对照组，在出血后的第一年，死亡率增加4-5倍，在第二年到第六年，增加2.2倍。继而的纵向的群组研究发现，那些活过前三个月的病人，在后来的7年观察当中，其死亡率显著高于对照组（32.9/19.4）.在一组人群基础的研究当中，在北肯塔州地区，十年的生存率是18%。

Long-term survival after primary ICH also appears to be decreased compared with controls from the general population matched for age and sex [4,6,17]. A retrospective cohort study identified 411 patients with first ever ICH and found that the annual risk of dying compared with controls was increased 4.5-fold during the first year after ICH and 2.2-fold during years two to six [4]. A subsequent longitudinal prospective cohort study evaluated patients who had survived the first three months after ICH and observed that the mortality at seven years was significantly higher than controls (32.9 versus 19.4 percent) [17]. In a population-based cohort of patients hospitalized after ICH in the Greater Cincinnati/Northern Kentucky area, the ten-year survival was 18 percent [5].