ĐẶC ĐIỂM LÂM SÀNG VÀ LIÊN QUAN GIỮA TRI GIÁC TRƯỚC PHẪU THUẬT VÀ KẾT CỤC ĐIỀU TRỊ BỆNH NHÂN CHẢY MÁU TỰ PHÁT TRONG NÃO

Abstract

Objectives: To describe the clinical features of spontaneous intracerebral hemorrhage (SIH) and the relationship between the preoperative Glasgow Coma Scale (GCS) and early surgical outcomes. Methods: A retrospective study on 100 patients with SIH who underwent surgery at Bach Mai hospital from 11/2015 to 5/2016. Clinical manifestations on admission and before surgery, history of co-morbidities were recorded. The outcome is considered as bad when the Glasgow Outcome Scale (GOS) is from 3 to 5 points. The relationship between preoperative GCS and outcome at hospital discharge was confirmed by OR, 95% CI. Results: The percentages of patients with hypertension, dyslipidemia, history of smoking, alcohol abuse, diabetes, vascular malformations and cirrhosis were 55%, 15%, 12%, 10%, 7%, 6% and 2%, respectively. Main clinical manifestations include; headache (72%), hypertension (66%), hemiplegia (56%), vomiting (55%), meningeal signs (42%), 7th nerve palsy (40%), speech disorder speech (34%), Babinski sign (28%) and GCS ≤ 8 (13%). The incidences of good and bad outcomes  were 57% and 43%, respectively. There were 70.4% of patients with GCS  ≤ 8 having bad outcome at discharge, this rate was 32.9% in patients with GCS > 8, (OR, 95% CI: 4.8 (1.9 – 12.7), p<0.01). Conclusions: Common manifestations of SIH on admission are headache, increased blood pressure, hemiplegia, and vomiting. Patients with preoperative GCS ≤ 8 are 4.8 times more likely to have a bad outcome after surgery than patients with GCS > 8.