中枢性急性眩晕综合征是否会威胁病人的生命?单个ICU连续3年的调查报告

Abstract

目的：研究中枢性急性眩晕综合症(acute vertigo syndrome, AVS)是否存在威胁生命的事件。方法：自2014年1月至2016年12月期间，所有中枢性AVS连续在一个ICU逗留的临床资料被纳入研究。入选标准为最初均以AVS为首发症状起病，并且后来都伴有危及生命事件的患者。结果：总共2466例成人危重症住入我院ICU，其中有25例以中枢性AVS为首发症状并后来伴威胁生命事件的患者，其患病率大约占ICU危重症患者的1.0%。这些患者的中位数年龄为60岁(23, 81)男：女之比为1.8:1。引起中枢性AVS的原因包括局灶性脑出血15例(60%)，脓毒性休克7例(28%)，脑梗塞2例(12%)。最频繁的威胁生命的事件是急性脑衰竭(24/25)。最常见的导致威胁生命的原因是病灶扩大(52.0%，包括早起血肿扩大8例，大面积梗塞2例，脑室出血进展2例，新缺血灶1例)，其次为脓毒性休克和继发性脓毒症事件(44.0%, 11/25)。所有威胁生命事件的病死率为64%。与生存组比较，非生存组的病灶扩大(68.8% vs. 22.2%, p < 0.05)、呼吸衰竭(93.8% vs. 55.6%, p < 0.05)、乳酸水平(5.3 vs. 1.3, p < 0.05)和序贯器官功能评分(6.9 vs. 3.4, p < 0.0001)明显高于生存组，而后续平均动脉血压(84.6 vs. 124, p < 0.0001)、GCS分(5.0 vs. 15.0, p < 0.0001)明显低于生存组的患者。多因素Cox回归分析证实，只有低GCS分与死亡的风险密切相关(RR = 0.784, 95%CI, 0.670~0.918; p < 0.005)。结论：中枢性急性AVS伴有威胁生命事件的患病率大约占成人ICU危重症的1.0%。而且发现只有低GCS分(<6分)是独立预报威胁中枢性AVS患者生命的事件，并伴有高死亡的风险。 Objective: To investigate whether the central acute vestibular syndrome (AVS) would be present a severe life-threatening events. Methods: Between Jan. 2014, and Dec. 2016, the clinical data of cases with central AVS from an ICU were conducted. Inclusion criteria for all cases were the onset of AVS, and then the patients with a severe life-threatening event were diagnosed. Results: A total of 2466 adult critically ill patients were admitted to our hospital, including 25 patients with central AVS as the first symptom and later with life-threatening events. The prevalence rate of them was about 1.0% of the ICU critical patients. The median age of these patients was 60 years (range 23 to 81 years), male: female ratio was 1.8:1. The causes of central AVS included focal cerebral hemorrhage in 15 cases (60%), shock in 7 cases (28%), and cerebral infarction in 3 cases (12%). The most frequent life-threatening event was acute brain failure (24/25), and the most common cause leading to brain failure was the lesion enlarged (54.2%, including hematoma enlargement in 8 cases, large area infarction or new infarction in 3 cases, and intraventricular hemorrhage in 2 cases). The next life-threatening event was septic shock/secondary sepsis (44.0%, 11/25). The fatality rate for all life-threatenheing events was 64%. Compared with the survival group, the patients with lesion enlarged (68.8% vs. 22.2%, p < 0.05), respiratory failure (93.8% vs. 55.6% p < 0.05), lactate level (5.3 mmol/l vs. 1.3 mmol/l, p < 0.05) and sequential organ failure assessment (SOFA) score (6.9 vs. 3.4, p < 0.0001) in the non-survival group were significantly higher, while late mean arterial blood pressure (84.6 mmHg vs. 124 mmHg, p < 0.0001), GCS score (5.0 score vs. 15 score, p < 0.0001) in the non-survival group were significantly lower. Conclusion: The prevalence of central AVS associated with life-threatening events accounts for about 1% of adult ICU critical illness. These central AVS may be a potential life-threatening event and with a high risk of death.