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目的 探讨复发性颅内出血的临床表现及危险因素。方法 回顾性分析了1995～1997年住院的256例脑出血病人中的15例(5.86 %)再出血患者的临床表现(含CT)、可能的危险因素。并随机选择24例单次出血的病人作对照比较。结果 9例男性 ,6例女性 ,首次出血平均年龄(61.5±9.0)岁 ,再次出血平均年龄(64.5±9.2)岁 ,两次出血平均间隔时间(38.0±20.8)个月 ,再出血组73.3 %的病人血压仍高于正常。首次出血位置 :基底节8例 ,脑叶6例 ,脑干1例 ,再出血部位与原出血部位不一致。最常见复发类型是基底节—基底节7例 ,脑叶—基底节3例 ,脑叶—脑叶3例 ,再出血组病人预后较差(p<0.05)。与24例无复发的脑出血相比 ,高血压控制不佳、脑叶血肿是复发的危险因素 (p<0.01) ,而与性别、糖尿病、烟、嗜酒、血脂等无关(p>0.05)。 结论 再发脑出血的机制是多方面的(包括高血压、大脑淀粉样血管病等) ,首次出血后血压的控制可以防止多数再出血的发生
Objective To investigate the clinical manifestations and risk factors of recurrent intracranial hemorrhage. Methods The clinical manifestations (including CT) and possible risk factors of 15 patients (5.86%) with recurrent hemorrhage were retrospectively analyzed in 256 ICH patients hospitalized in 1995-1997. A total of 24 patients with single bleeds were randomly selected for comparison. Results The average age of the first hemorrhage (61.5 ± 9.0) years, the average age of the second hemorrhage (64.5 ± 9.2) years, the average interval between the two hemorrhage (38.0 ± 20.8) and the rebleeding group (73.3% The patient’s blood pressure is still higher than normal. Bleeding site: 8 cases of basal ganglia, 6 cases of brain lobe, brain stem in 1 case, rebleeding site and the site of the original bleeding is inconsistent. The most common type of recurrence was basal ganglia-basal ganglia in 7 cases, lobar-basal ganglia in 3 cases, lobar-lobe in 3 cases, and rebleeding group with poor prognosis (p <0.05). Compared with 24 non-recurrent intracerebral hemorrhage, hypertension control was poor, and lobar hematoma was a risk factor for recurrence (p <0.01), but not related to gender, diabetes, smoking, alcohol consumption, . Conclusion The mechanism of recurrent cerebral hemorrhage is multifaceted (including hypertension and cerebral amyloid angiopathy). The control of blood pressure after the first hemorrhage can prevent the occurrence of most rebleeding