Tsurushima H, Kamezaki T, Yamabe-Nakamura H, Meguro K, Ohashi N, Nose T
Department of Neurosurgery, Ibaraki Seinan Medical Center Hospital, Japan.
No Shinkei Geka. 1998 Oct;26(10):897-901.
The treatments of putaminal hemorrhages (PH) were evaluated in 14 patients (15 hematomas) with chronic renal failure (CRF). We compared the data of our series with the data of co-operative study (1990) on PH. With regard to consciousness level (Neurological Grading, NG) and hematoma volume, significantly more serious cases were observed in PH with CRF than in PH of the co-operative study. In PH with CRF, mortality (40%) was significantly higher than that in PH of the co-operative study. However, the mortality rate was 0%, 0%, 20%, and 100% in NG1, 2, 3, and over 4b. The mortality rate was 0% in non-surgically treated cases with 0 to 30 ml of hematoma volume, and 0% in surgically treated cases with 10 to 50 ml of hematoma volume. These mortality rates were equal to those of the co-operative study with the same NG, and equal to those of the co-operative study with the same hematoma volume. With respect to functional prognosis, "good" (ADL1 and 2) resulted in 67% of non-surgically treated cases with NG1 to 2, and in 33% of surgically treated cases with NG3 to 4a. "Good" resulted in 33% of non-surgically treated cases with 0 to 30 ml of hematoma volume, and in 40% of surgically treated cases with 10 to 50 ml of hematoma volume. These morbidity rates were equal to those of the co-operative study with the same NG, and equal to those of the co-operative study with the same hematoma volume. Therefore, the high mortality in PH with CRF was suspected to be due to the fact that, in our study, there was a higher distribution of serious cases. These findings indicate that protection against enlargement of hematomas in the acute phase may bring about improvement of prognosis in PH with CRF.
对14例（15处血肿）慢性肾功能衰竭（CRF）患者的壳核出血（PH）治疗情况进行了评估。我们将本系列数据与关于PH的合作研究（1990年）数据进行了比较。在意识水平（神经分级，NG）和血肿体积方面，CRF合并PH患者中观察到的严重病例明显多于合作研究中的PH患者。CRF合并PH患者的死亡率（40%）显著高于合作研究中PH患者的死亡率。然而，NG1、2、3及超过4b级时的死亡率分别为0%、0%、20%和100%。血肿体积为0至30 ml的非手术治疗病例死亡率为0%，血肿体积为10至50 ml的手术治疗病例死亡率为0%。这些死亡率与相同NG级别的合作研究结果相当，也与相同血肿体积的合作研究结果相当。在功能预后方面，“良好”（日常生活活动能力1级和2级）在NG1至2级的非手术治疗病例中占67%，在NG3至4a级的手术治疗病例中占33%。血肿体积为0至30 ml的非手术治疗病例中“良好”占33%，血肿体积为10至50 ml的手术治疗病例中“良好”占40%。这些发病率与相同NG级别的合作研究结果相当，也与相同血肿体积的合作研究结果相当。因此，怀疑CRF合并PH患者死亡率高是因为在我们的研究中严重病例分布更多。这些发现表明，急性期防止血肿扩大可能会改善CRF合并PH患者的预后。
