摘要
目的了解急诊人院3h内自发性蛛网膜下腔出血（SSAH）患者Terson综合征的发病情况及其相关因素，分析眼内出血与患者病情的关系。方法前瞻性研究。74例连续的急诊人院并确诊为SSAH的患者纳入研究。患者均于人院3h内行眼底检查，情况允许者行眼底照相。首次眼底检查的同时由脑外科医师对其做Hunt—Hess分级。分别在入院后1、3、7d，2周，1、3个月时检查眼底。记录患者性别、年龄、Hunt—Hess分级、眼底出血类型、是否死亡等资料。分析Terson综合征的发病比例及其与年龄、性别、Hunt—Hess分级的关系，以及不同类型眼内出血与Hunt—Hess分级及死亡率的关系。结果74例SSAH患者中，19例31只眼发生Terson综合征，发病比例为25．7％。Terson综合征与非Terson综合征患者性别构成比比较，差异无统计学意义（x2=0．071，P=0．790）；年龄构成比比较，差异无统计学意义（P=0．203）；Hunt—Hess分级构成比比较，差异有统计学意义（P=0．000）。视网膜前出血与玻璃体积血的患者和视网膜内出血的患者中Hunt—Hess分级V级所占比例比较，差异有统计学意义（P=0．041）。眼内出血均在首次眼底检查中发现。Terson综合征患者死亡13例，死亡率为68．4％。视网膜前出血与玻璃体积血患者和视网膜内出血患者的死亡率比较，差异有统计学意义（P=0．046）。存活的6例Terson综合征患者中，4例患者眼底出血自行吸收，2例患者行玻璃体切割手术。结论急诊入院的SSAH患者Terson综合征发病比例为25．7％。其发生与患者性别、年龄无关，与全身情况有关。眼内出血均发生在SSAH急性期。眼内出血重的患者全身情况差，死亡率高。
Objective To investigate the incidence, risk factors and relationship with intraocular hemorrhage of Terson＇s syndrome among patients with spontaneous subarachnoid hemorrhage （SSAH） after emergency admission. Methods Seventy-four consecutive patients with SSAH from June 2010 to September 2011 were prospectively examined. A direct ophthalmoscope examination was performed in all participants within three hours after emergency admission. If circumstances permit, fundus photos were taken. When initial fundus examination was conducted, the Hunt-Hess grade was classified by the brain surgeon. The fundus examination was taken on the 1st, 3rd, and 7th day, 2 weeks, 1 month, and 3 months after emergency admission. The details were recorded, including sex, age, bleeding patterns, Hunt-Hess grade and death. The incidence of Terson＇s syndrome was analyzed and correlated with sex, age and Hunt-Hess grade. The relationship between intraocular hemorrhage and Hunt-Hess grade and mortality was analyzed. Results Among the 74 patients, 19 were suffering from Terson＇s syndrome, 31 eyes involved. The incidence of Tersonrs syndrome was 25.7%. Statistical analysis demonstrated that the sex of the patient was randomly distributed （x2 = 0. 071, P = 0. 790）, and the age components were also randomly distributed （Fisherrs exact test, P= 0. 203）. The Hunt-Hess grade components were non-randomly distributed （Fisher＇ s exact test,P=0. 000）. Among the patients with preretinal hemorrhage and vitreous hemorrhage, Hunt- Hess grade V was in 76.9% patients; among inter-retinal hemorrhage, Hunt-Hess grade was in 16.. 7% of patients. The distribution was non-random （Fisher＇s exact test, P=0. 041）. All intraocular hemorrhageswere found at the time of first fundus examination. The mortality from Terson＇s syndrome was 68.4 % （13/ 19） according to the follow-up investigation. The mortality in patients with vitreous hemorrhage and preretinal hemorrhage was statistically different （Fisherrs exact test, P= 0. 046） from patients with inter- retinal hemorrhage. Among the six recovered Terson＇s syndrome patients, two of them were recovered from vitrectomy, and the other four were recovered from self-absorption. Conclusions A higher frequency （25.70%） of Tersonrs syndrome was observed in patients with SSAH. The incidence is highly related to the general condition of the patient but not to the sex or age. Intraocular hemorrhage is more likely to happen in the early time of SSAH. People with more severe intraocular hemorrhage may have worse general condition or higher mortality.
出处
《中华眼底病杂志》
CAS
CSCD
北大核心
2013年第4期392-395,共4页
Chinese Journal of Ocular Fundus Diseases
