고혈압성 뇌실질내 혈종에 대한 임상적 고찰

Abstract

[영문]

[한글]

저자는 1977년 11월부터 1985년 10월까지 연세대학교 의과대학 부속 세브란스 병원에

내원하여 고혈압성 뇌실질내 혈종으로 진단된 553명의 환자를 분석하여 다음과 같은 결론

을 얻었다

1. 환자의 연령은 50대가 가장 많았으며, 평균나이는 51세였다. 남녀간 발생빈도의 차

이는 없었다.

2. 계절적 발생빈도는 3월 및 10월경에 높은 발생빈도를 보였다.

3. 혈종부위별 발생빈도는 과핵이 45.7%, 시상부가 21.1%, 뇌피질하가 16.2%, 뇌교가 4

.8%, 소뇌가 5.9%, 뇌실내 출혈이 5.9%였다.

4. 혈종부위별 사망률은 과핵이 23.3%, 시상부가 26.4%, 뇌피질하가 32.2%, 뇌교가 59.

2%, 소뇌가 21.1%, 뇌실내 출혈이 39.3%였다. 전체 사망률은 28%였다.

5. 입원 당시 의식수준과 혈종부위와는 유의적인 상관 관계가 없었다.

6. 과핵, 시상부, 뇌피질하 혈종은 양이 30cc이상이면 환자의 예후를 위하여 수술적 치

료를 하는 것이 바람직하였다.

7. 뇌교 혈종은 수술이나 보존적 치료 모두 높은 사망률을 보였다.

8. 소뇌 혈종은 최대직경이 3㎝이상인 경우 수술적 처치를 시행하는 것이 바람직하였다

.

9. 뇌실내 출혈이 동반되면 사망률이 높아졌다.

10. 뇌전산화 단층촬영상 중앙선 이동이 심할수록 사망률이 높았다.

11. 수술시기는 대부분의 경우 발병 후부터 병원 내원까지의 시간 소모가 주된 영향을

주었다.

A clinical analysis of 553 cases of hypertensive intervertebral hemorrhage

Jin Woo Chang

Department of Medical Science, Graduate School, Younsei University

(Directed by Sang Sup Chung, M.D., D.M.Sc)

The author analysed 553 Ct-scan confirmed cases of hypertensive intervertebral

hemorrhages between November 1977 and October 1985 at Severance Hospital of Yonsei

University College of Medicine.

The results are summarized as follows.

1. The largest number of patients were in the 6th decade (34.3%) with a mean age

of 51 years. There was no difference in incidence by sex.

2. Seasonal distribution of the cases was evident with high incidences in March &

October.

3. According to anatomical sites, the incidence of intracerebral hemorrhage was

greatest in the putamen with 45%, followed by 21.1% in the thalamus, 16.2% in the

subcortex, 5.9% in the cerebellum, 5.9% in the ventricles and 4.8% in the pons.

4. According to hematoma sites, mortality rates were 23.3% in the putamen, 28.4%

in the thalamus, 32.2% in the subcortex, 59.2% in the pons, 21.2% in the cerebellum

and 39.3% in the ventricles. The overall mortality rate was 28%.

5. There was no evidence of statistical correlation between the initial mental

state on admission and the site of the hematoma.

6. When the size of the hematoma was 30cc or greater, there was frequent surgical

intervention in the hematomas of the putamen, the thalamus, and the subcortex.

7. Regardless of conservative treatment or surgical intervention, pontine

hemorrhages resulted in higher mortality rates.

8. When the maximal diameter in cerebellar hematoma was 3cm or greater, surgical

intervention was the most frequent choice of treatment.

9. Higher mortality rate was observed in the presence of intraventricular

hemorrhage than in the absence of intra-ventricular hemorrhage.

10. When severe midline shift was evident by the CT scan, mortality rates were

higher.

11. The timing of the surgical intervention was frequently influenced by the time

interval between the onset of hemorrhage and the time of hospital arrival.