脑出血病因、危险因素及血肿扩大的临床研究

发布时间：2018-05-17 18:24

本文选题：脑出血 + 病因　；参考：《吉林大学》2017年硕士论文

【摘要】：研究背景:在中国各大疾病死亡原因中,脑血管病居于前列,疾病致残率较高,给家庭和社会带来极大负担。脑出血发病率近几年来增加幅度较大,特别是青年脑出血发病率呈增长趋势。脑出血病程中均可出现血肿扩大,导致病情加重、预后不良。了解脑出血患者病因、危险因素及血肿扩大的相关因素,可为其预防和早期治疗提供临床依据,进而减少疾病负担。目的:探讨脑出血的病因、危险因素及血肿扩大相关因素,为临床决策提供依据。方法:收集2015年1月~2016年12月在吉林大学第二医院神经内、外科住院治疗的274例急性脑出血患者的详细病例资料,回顾性分析其流行病学特征、病史、临床特征、实验室及影像学检查,采用SPSS 22.0统计软件进行分析,讨论其病因、危险因素及血肿扩大相关因素。结果:1.流行病学特征:274例患者中,男性166例,女性108例,各占60.6%和39.4%,男女性别比为1.54:1。发病平均年龄57.3±12.72岁,高发年龄在45~64岁年龄组,共158例,占72.3%;其次为65~74岁年龄组49例,占17.9%;31~44岁年龄组36例,占13.1%;年龄高于75岁者27例,占9.9%。脑出血发病率最高在1月份(占16.8%),秋冬两季共161例,占58.7%,明显高于夏季(44例,占16.1%)。2.病因:高血压脑出血152例,占55.5%;颅内动脉瘤22例,占8.0%;烟雾病8例,占2.9%;血管畸形4例,血液病2例,瘤卒中1例,抗血小板聚集药物应用史10例,妊娠1例。3.危险因素:单因素分析显示,与健康对照组相比,脑出血组患者饮酒、高血压、脑梗死病史、APTT、TG、LDL-C、HDL-C、血糖、Hcy、Cys C及超敏C反应蛋白等差异有统计学意义(P0.05),Logistic回归分析显示脑梗死病史、高血压及血清高水平LDL-C为脑出血的独立危险因素(P0.05)。4.血肿扩大相关因素:单因素分析显示,与血肿未扩大组相比,血肿扩大组患者的发病距首次行头部CT检查时间、入院GCS评分、入院NIHSS评分和血清白细胞计数、中性粒细胞计数、PT、APTT、TG、HDL-C、APO-A1、血糖及Cys C水平差异有统计学意义(P0.05)。Logistic回归分析显示较短的发病距首次行头部CT检查时间、低入院GCS评分、高入院NIHSS评分、血清高水平HDL-C及血糖为脑出血急性期血肿扩大独立危险因素(P0.05)。结论:1.脑出血发病男性多于女性,男女性别比1.54:1,中老年患者发病率较高,秋冬季节为脑出血高发季节。2.脑出血病因为高血压、动脉瘤、烟雾病、血管畸形、血液病、瘤卒中、抗血小板聚集药物应用、妊娠等;脑梗死病史、高血压及血清高水平LDL-C为脑出血的独立危险因素。3.脑出血早期血肿扩大的危险因素为:较短的发病距首次行头部CT检查时间、低入院GCS评分、高入院NIHSS评分、血清高水平HDL-C及血糖。
[Abstract]:Background: cerebrovascular diseases are among the leading causes of death in China. The incidence of intracerebral hemorrhage (ICH) has increased greatly in recent years, especially in young people. Hematoma enlargement can occur in the course of intracerebral hemorrhage, leading to aggravation of the disease and poor prognosis. Understanding the etiology, risk factors and related factors of hematoma enlargement in patients with intracerebral hemorrhage can provide clinical basis for its prevention and early treatment, and then reduce the burden of disease. Objective: to explore the etiology, risk factors and hematoma enlargement related factors of intracerebral hemorrhage. Methods: 274 cases of acute intracerebral hemorrhage were collected from January 2015 to December 2016 in the second Hospital of Jilin University, and their epidemiological characteristics, history and clinical features were analyzed retrospectively. The etiology, risk factors and related factors of hematoma enlargement were analyzed by SPSS 22. 0 statistical software. The result is 1: 1. Of the 274 patients, 166 were males and 108 were females, accounting for 60.6% and 39.4%, respectively, with a sex ratio of 1.54: 1. The average age of onset was 57.3 卤12.72 years old, the high incidence age group was 45 ~ 64 years old (158 cases, 72.3%), the second was 65 74 years old (49 cases), accounting for 17.9% (3144 years), 36 cases (13.1%), and 27 cases (9.9B) in the age group over 75 years old. The highest incidence of intracerebral hemorrhage was in January (16.8%) and in autumn and winter (161 cases), accounting for 58.7 cases, which was significantly higher than that in summer (16.1%). Causes: 152 cases of hypertensive cerebral hemorrhage (55.5%), 22 cases of intracranial aneurysms (8.0%), 8 cases of moyamoya disease (2.9%), 4 cases of vascular malformation, 2 cases of hematologic diseases, 1 case of tumor stroke, 10 cases of antiplatelet aggregation drug use history, 1 case of pregnancy. Risk factors: univariate analysis showed that there were significant differences in alcohol consumption, hypertension, history of cerebral infarction, HDL-C, HcyCys C and hypersensitive C-reactive protein between patients with cerebral hemorrhage and healthy controls (P 0.05 logistic regression analysis). Hypertension and high serum LDL-C were independent risk factors for intracerebral hemorrhage. Factors related to hematoma enlargement: univariate analysis showed that the first time of head CT examination, admission GCS score, admission NIHSS score and serum white blood cell count were observed in the hematoma enlargement group compared with the unenlarged hematoma group. There were significant differences in plasma glucose and Cys C levels between the two groups (P < 0.05). Logistic regression analysis showed that the first time of head CT examination, low admission GCS score, and high admission NIHSS score were shorter than those before onset. High level of serum HDL-C and blood glucose were independent risk factors of hematoma enlargement in acute stage of intracerebral hemorrhage (P 0.05). Conclusion 1. The incidence of intracerebral hemorrhage was higher in male than in female, the ratio of male to female was 1.54: 1. The incidence of intracerebral hemorrhage was higher in middle-aged and elderly patients than in female, and the incidence of intracerebral hemorrhage was higher in autumn and winter. Cerebral hemorrhage due to hypertension, aneurysm, moyamoya disease, vascular malformation, hematopathy, stroke, antiplatelet aggregation drug use, pregnancy, history of cerebral infarction, hypertension and high serum LDL-C are the independent risk factors of cerebral hemorrhage. The risk factors of hematoma enlargement in early stage of intracerebral hemorrhage were as follows: short time of head CT examination, low admission GCS score, high admission NIHSS score, high serum HDL-C and blood glucose.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.34

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