Ndubuisi Chika Anele, Okhueleigbe Mark Oseghale, Mbadugha Tobechi Nwankwo, Ndukuba Kelechi Onyenekeya, Inojie Moses Osaodion, Ohaegbulam Samuel Chukwunoyerem
Department of Neurosurgery, Memfys Hospital, Enugu, Nigeria.
Niger Postgrad Med J. 2019 Apr-Jun;26(2):113-117. doi: 10.4103/npmj.npmj_22_19.
Spontaneous intracerebral haemorrhage (SICH) is a major cause of stroke worldwide. SICH management is still challenging, especially in developing countries. This study highlights certain factors affecting outcome of SICH managed in a Nigerian Neurosurgical centre, on a background of the modernisation of the patient care facilities.
Retrospective analysis of patients managed for SICH at Memfys Hospital for Neurosurgery and Neurology in Enugu from years 2009-2016. All patients had computed tomography or magnetic resonance imaging for diagnosis. Treatment included medical, surgical and intensive care unit (ICU) care. Patients with aneurysmal subarachnoid haemorrhage and trauma were excluded. Factors analysed include age, admission Glasgow Coma Score (GCS), haematoma location, complications encountered during admission, duration of hospital stay and 6-month Glasgow Outcome Score (GOS).
There were 66 cases, age range of 21-85 years (mean 57 years). A total of 30 (45.5%) patients were admitted with GCS ≤ 8/15; 63.3% of these died within 6 months. The proportion of mortalities was 63.6% (>70 years) and 35.6% (41-70 years). Most commonly associated complication was chest infection 27 (40.9%), with 56.6% mortality. Common haematoma locations were basal ganglia (43.9%) and lobar haemorrhage (40.9%) with a similar effect on outcome (P = 0.098). Outcomes were GOS 1: (43.9%), GOS 5: (30.3%) and GOS 4: (13.6%). Among 42 (63.3%) admitted to ICU, 25 (59.5%) died, while 11 (26.2%) achieved GOS of ≥ 4 at 6 months. Those discharged between days 11 and 20 had 26.7% mortality while 53.3% were independent.
Good admission GCS, absence of chest infections, younger age group are predictors of good outcome following SICH. Anatomical location of haemorrhage alone does not have a significant impact on 6 months' mortality.
自发性脑出血（SICH）是全球范围内中风的主要原因。SICH的管理仍然具有挑战性，尤其是在发展中国家。本研究在患者护理设施现代化的背景下，突出了影响尼日利亚一家神经外科中心SICH治疗结果的某些因素。
对2009年至2016年期间在埃努古的Memfys神经外科和神经病学医院接受SICH治疗的患者进行回顾性分析。所有患者均通过计算机断层扫描或磁共振成像进行诊断。治疗包括药物治疗、手术治疗和重症监护病房（ICU）护理。排除患有动脉瘤性蛛网膜下腔出血和创伤的患者。分析的因素包括年龄、入院时格拉斯哥昏迷评分（GCS）、血肿位置、入院期间遇到的并发症、住院时间和6个月时的格拉斯哥预后评分（GOS）。
共有66例病例，年龄范围为21至85岁（平均57岁）。共有30例（45.5%）患者入院时GCS≤8/15；其中63.3%在6个月内死亡。死亡率在>70岁的患者中为63.6%，在41至70岁的患者中为35.6%。最常见的相关并发症是肺部感染27例（40.9%），死亡率为56.6%。常见的血肿位置是基底节区（43.9%）和脑叶出血（40.9%），对预后的影响相似（P = 0.098）。预后为GOS 1：（43.9%），GOS 5：（30.3%）和GOS 4：（13.6%）。在42例（63.3%）入住ICU的患者中，25例（59.5%）死亡，而11例（26.2%）在6个月时GOS≥4。在第11天至第20天出院的患者中，死亡率为26.7%，而53.3%的患者能够独立生活。
入院时GCS良好、无肺部感染、年龄较轻是SICH后良好预后的预测因素。仅出血的解剖位置对6个月死亡率没有显著影响。
