青年和中老年脑出血危险因素及预后的相关研究

发布时间：2018-03-20 16:20

  本文选题：危险因素　切入点：脑出血　出处：《泸州医学院》2014年硕士论文　论文类型：学位论文

【摘要】：目的：探讨青年和中老年患者脑出血的危险因素及预后的相关性。资料与方法：1、前瞻性登记2012年6月1日-2013年11月30日在四川省人民医院神经内科、神经外科及康复科连续入院的所有发生自发性脑出血患者348例。纳入患者均符合美国成人自发性脑出血治疗指南2010年的诊断标准。动态观察患者住院期间情况及全面收集可能与自发性脑出血相关的临床及实验室检查数据。2、将所有登记在册的脑出血患者按年龄分为＜45岁的青年组和≥45岁的中老年组。3、患者出院后3个月、6个月末进行电话随访，，了解预后情况。电话随访主要内容：1)患者生存或死亡状态；2)脑卒中的复发情况；3）服药情况；4）有无残疾。残疾判定采用改良Rankin评分量表(Modified RankinScale，MRS)。MRS大于等于3分为不良预后即死亡/残疾（死亡与残疾的总和），小于3分为预后良好即生活自理。主要判效指标：（1）随访期末的死亡率；（2）随访期末的不良结局（即死亡/残疾）率。4、使用SPSS17.0软件包对数据进行统计分析，计量资料采用均数±标准差（x±s）或中位数描述。两组计量资料相比较，若服从正态分布，采用T检验，若非正态分布，采用秩和检验。计数资料的两组比较，采用卡方检验。当四格表中出现理论频数（theoretical frequency，T）小于5时，采用四格表确切概率法。5、对可能影响患者发病后3月、6月死亡及死亡/残疾的各种危险因素进行单因素分析，对P≤0.10的危险因素进行多因素分析，校正混杂因素，确定影响预后的独立危险因素。 结果：1、本研究共纳入符合标准的病例308例，其中青年组脑出血患者46（14.9%）例，中老年组脑出血患者262（85.1%）例。青年组年龄范围为21-44岁，平均年龄38.8±7.1岁，其中男性36（78.3%）例，女性10(21.7%)例。中老年组年龄范围为45-90岁，平均年龄66.6±11.5岁，其中男性165（63.0%）例，女性97(37.0%)例。经X2检验，P＜0.05，两组男性发病均多于女性，差异有统计学意义。2、住院期间青年组脑出血共死亡2人（8.7%），出血部位分别位于脑干及多灶性出血。中老年脑出血患者住院期间共死亡28人（10.7%)，出血部位分别位于脑干、基底节、丘脑及多灶性出血。3、高血压是两组脑出血患者发病最重要的危险因素，此外，糖尿病及高脂血症是中老年脑出血发病的主要危险因素,而烟酒史及脑血管畸形是青年脑出血主要的危险因素。影响两组脑出血患者的危险因素中性别、糖尿病、高血压及卒中史差异有统计学意义，两组患者住院期间死亡/残疾之间差异有统计学意义。4、入院病情严重程度（入院时NIHSS入院评分）是患者3月、6月末死亡的独立影响因素。5、组别及NIHSS评分是患者3月、6月末死亡/残疾的独立危险因素，入院随机血糖是患者6月末的死亡/残疾独立危险因素。 结论：1、控制好血压外，中老年人还应控制好血糖及血脂，青年人应注重养成戒烟、限酒等良好的生活方式，可以有效降低脑出血的发生，改善脑出血预后。2、发生在脑干部位的脑出血死亡率高，发生在脑干、丘脑部位的患者预后差。3、年龄45岁以上的中老年人，入院时随机血糖明显升高，神经功能缺损症状明显者，出现不良结局（残疾或死亡）的可能性越大。
[Abstract]:Objective: To investigate the correlation between the risk factors and prognosis in young and elderly patients with cerebral hemorrhage. Materials and methods: 1 prospective registration June 1, 2012 -2013 year in November 30th in the neurology department of Sichuan Provincial People's Hospital, Department of neurosurgery and rehabilitation of all consecutive patients with spontaneous intracerebral hemorrhage in 348 cases. Patients were accorded with the diagnostic standard guidelines for the treatment of adults in the United States in 2010 spontaneous cerebral hemorrhage. Dynamic observation of patients during hospitalization and comprehensive collection of clinical and laboratory data of.2 may be associated with spontaneous intracerebral hemorrhage, all registered patients with cerebral hemorrhage were divided into less than 45 year old youth group and over 45 years old group.3, 3 months after discharge from hospital, 6 at the end of a telephone follow-up was conducted to understand the prognosis. The main contents of telephone follow-up: 1) patient survival or death; 2) the recurrence of stroke; 3) pill 4); there is no disability. Disability was determined by modified Rankin scale (Modified, RankinScale, MRS).MRS is greater than or equal to 3 points for the poor prognosis of death / disability (sum of death and disability), less than 3 points for the good prognosis is living. The main criterion: (1) at the end of follow-up mortality; (2) the adverse outcome at the end of follow-up (i.e. the death / disability rate of.4), SPSS17.0 software package was used for statistical analysis of the data, the measurement data using the mean and standard deviation (x + s) or median description. Two groups of measurement data are compared, if the normal distribution, using T test, it is the normal distribution, Wilcoxon test. The comparison between the two groups of count data, using the chi square test. When the four tables appear in the theoretical frequency (theoretical frequency T) is less than 5, using four exact method.5, may impact on the patients after March June, death and death / disability all The risk factors were analyzed by univariate analysis, multivariate analysis of risk factors of P is less than or equal to 0.10, adjusted for confounding factors, determine the independent prognostic factors.
缁撴灉锛

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