605例重症脑血管病死亡病例分析

发布时间：2018-04-22 08:54

本文选题：急性重症脑血管病 + 脑死亡　；参考：《大连医科大学》2014年硕士论文

【摘要】：目的：分析急性重症脑血管病死亡病例的分布及临床特征，探讨脑死亡与心肺死亡发生、时间差异，以期为降低急性重症脑血管病病死率、了解脑死亡提供参考。方法：回顾性分析，收集大连医科大学附属第一医院神经ICU、中心ICU以及急诊ICU病房2010年01月至2013年06月急性重症脑血管病死亡病例共605例。分析605例急性重症脑血管病死亡病例的一般情况、生存时间、临床特征、死亡原因等临床资料。通过归纳整理605例急性重症脑血管病死亡患者的意识状态、脑干反射情况、GCS评分、FOUR评分，收集符合临近脑死亡和临床脑死亡标准的病例，分别分析临近脑死亡、临床脑死亡转归、发生时间，，以及临近脑死亡至心肺死亡、临近脑死亡至临床脑死亡的时间分布情况。采用SPSS17.0统计软件进行数据分析。使用Frequencies、Crosstabs对分类变量的频数、构成比进行统计分析，使用Kaplan-Meier法和Log Rank检验法对事件发生时间进行生存分析。以P＜0.05为差异有统计学意义。结果： 1.605例急性重症脑血管病男性372例，女性233例，男女比例1.6：1。男性平均年龄（65.11±14.885）岁，女性平均年龄（71.75±13.264）岁；44岁以下39例，男女比例4.6：1；45-59岁154例，男女比例3.1：1；60-74岁169例，男女比例1.4：1；75岁以上243例，男女比例1.1：1。 2.605例急性重症脑血管病患者缺血性脑卒中252例（41.7%），男性142例（56.3%），女性110例（43.7%）；出血性脑卒中336例（55.5%），男性220例（65.5%），女性116例（34.5%）。合并肺内感染394例（65.1%），合并电解质紊乱341例（53.7%）；住院天数范围1-138小时，1-3天内死亡的339例（56.0%）。其中，死于原发病的389例（64.3%），死于并发症的141例（23.3%）。 3.605例急性重症脑血管病患者中符合临近脑死亡标准的247例（40.8%），临近脑死亡至心肺死亡的时间范围2-360小时，平均时间（13.14±1.570）小时，中位数9小时。247例临近脑死亡中有202例（81.0%）先期符合临床脑死亡的患者，临近脑死亡至临床脑死亡的时间范围0-19小时，平均时间（4.11±0.253）小时，中位数3小时。结论： 1、急性重症脑血管病死亡患者的死亡比例与年龄相关，即年龄越大死亡比例越高；死亡患者男性比例高，且平均死亡年龄低女性；出血性脑卒中的死亡比例高于缺血性脑卒中，出血性脑卒中男性死亡年龄以中年居多，女性以年轻老年居多。 2、急性重症脑血管病病情重，进展快3天内病死率高；死亡原因首先是原发病（脑疝），其次是并发症。 3、急性重症脑血管病死亡患者临近脑死亡和临床脑死亡出现率高。大部分在出现临床脑死亡前3小时即出现临近脑死亡；大部分在出现心肺死亡前9小时即出现临近脑死亡。
[Abstract]:Objective: to analyze the distribution and clinical characteristics of acute severe cerebrovascular disease and to explore the time difference between brain death and cardiopulmonary death in order to reduce the death rate of acute severe cerebrovascular disease and to provide reference for understanding brain death. Methods: a total of 605 patients with acute severe cerebrovascular diseases were collected from the first affiliated Hospital of Dalian Medical University, central ICU and emergency ICU ward from January 2010 to June 2013. The general situation, survival time, clinical features and causes of death of 605 patients with acute severe cerebrovascular disease were analyzed. By summing up the consciousness, brainstem reflex and Four scores of 605 patients with acute severe cerebrovascular death, we collected the patients who met the criteria of near brain death and clinical brain death, and analyzed the adjacent brain death respectively. The time distribution of clinical brain death to cardiopulmonary death and clinical brain death. SPSS17.0 statistical software was used to analyze the data. The frequency and composition ratio of the classified variables were statistically analyzed by using the frequency and composition ratio of the classified variables, and the survival time of the event was analyzed by Kaplan-Meier method and Log Rank test method. The difference was statistically significant (P < 0.05). Results: 1.605 cases of acute severe cerebrovascular disease in men 372 cases, female 233 cases, male to female ratio 1.6: 1. The average age of male was 65.11 卤14.885 years old, the average age of female was 71.75 卤13.264 years old and 39 cases were under 44 years old, the ratio of male and female was 4.6: 145-59 years old 154 cases, the ratio of male and female was 3.1: 1 + 60-74 years old 169 cases, the ratio of male and female was 1.4: 1 / 75 years old or above, the ratio of male and female was 1.1: 1. There were 2.605 patients with acute severe cerebrovascular disease with ischemic stroke, 2.605 patients with acute severe cerebrovascular disease with ischemic stroke, one hundred and forty-two male patients with ischemic stroke, one hundred and forty-two male patients with acute cerebral apoplexy, and one hundred and thirty-one female patients with acute cerebral apoplexy, 55.5 patients with hemorrhagic stroke, 65.5 patients with male and 34.5 patients with female cerebral apoplexy. There were 394 cases with intrapulmonary infection and 341 cases with electrolyte disturbance. 339 cases died within 1-3 days of hospitalization in the range of 1-138 hours. Among them, 389 cases died of primary disease and 141 cases died of complications. Of the 3.605 patients with acute severe cerebrovascular disease, the time range from brain death to cardiopulmonary death was 2-360 hours, and the average time was 13. 14 卤1. 570 hours. The median time range from brain death to clinical brain death was 0-19 hours, the average time was 4.11 卤0.253 hours, and the median time was 3 hours. Conclusion: 1. The death rate of patients with acute severe cerebrovascular disease is related to age, that is, the higher the age, the higher the death rate; the higher the male proportion is, and the lower the average death age is, the higher the death rate of hemorrhagic stroke is compared with that of ischemic stroke. The age of death of hemorrhagic stroke was mostly middle age in male and young and old in female. 2, the acute severe cerebrovascular disease is serious, the death rate is high within 3 days, the cause of death is the primary disease (cerebral hernia), the second is the complication. 3. The incidence of near brain death and clinical brain death in patients with acute severe cerebrovascular disease is high. Most of them appeared near brain death 3 hours before clinical death and 9 hours before cardiopulmonary death.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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