青年与中老年脑出血临床特点分析

发布时间：2018-06-20 23:05

本文选题：青年与中老年脑出血 + 病因　；参考：《山东大学》2017年硕士论文

【摘要】：研究背景与目的:自发性脑出血(spontaneous intracerebral haemorrhage,sICH)发病率仅次于缺血性脑卒中,占急性期脑血管病20%-30%,是病人致残和致死的主要原因。sICH病因及危险因素众多,好发于中老年人,临床表现因出血部位而异。但近年有研究发现其呈现年轻化趋势。青年与中老年脑出血在病因、危险因素、临床表现、影像学检查及临床结局等方面有一定差异,针对脑出血不同病因和危险因素行积极预防与治疗可有效减少脑出血发生和复发。脑出血影像学诊断主要是颅脑CT(Computed Tomography),其次是颅脑 MRI(Magnetic Resonance Imaging)。磁共振血管造影(magnetic resonance angiography,MRA)、CT 血管造影(Computed Tomography angiography,CTA)及数字减影脑血管造影(Digital subtraction angiography,DSA)可有助于脑出血病因的诊断,但目前脑出血后行血管造影等检查的病人较少。近年来,缺血性脑卒中病因分型及危险因素等研究较多,而国内外对出血性脑血管病病因分型及危险因素等研究较少。病因分类及危险因素等分析有助于评估患者、选择有效的治疗方案、判断预后以及制定二级预防策略。临床表现差异有助于脑出血早发现、早干预。该研究目的是通过收集与分析脑出血患者临床资料,总结脑出血常见病因及危险因素等方面相关特点,比较两者之间的差异,提高临床医师对该病的全面认识,为脑出血的系统诊治提供依据。研究方法:回顾性收集我院神经内科2011年01月至2016年12月期间收治的脑出血病人442例。汇总所收集病例一般资料,包括性别、年龄、不良生活方式(如吸烟、饮酒、吸毒及药物滥用情况)、既往疾病史(高血压、糖尿病、冠心病、高脂血症以及卒中病史)、出血部位、临床表现以及出院临床结局等相关资料;实验室检测结果(血常规、血脂血糖、肝肾功能、凝血功能、病毒系列及风湿系列指标等);影像学检查相关资料(颅脑CT、MRI、MRA、MRV、CTA及DSA)。因不同年龄出血病因、危险因素等方面不尽相同,将所收集病人分为两组,45岁青年组和≥45岁中老年组,应用SPSS21行医学统计学分析,比较两组脑出血患者年龄及性别、出血部位、常见病因、危险因素、临床表现以及影像学检查等差异。研究结果:1.发病年龄与性别差异:该研究发现,脑出血平均发病年龄男性女性早。45岁青年脑出血例数占全部脑出血患者14.3%。所有脑出血病例男性多于女性,尤其是青年脑出血组男性明显多于女性,差异具有统计学意义(P0.05)。2.出血部位:研究发现基底节区是脑出血最多见的部位,其次是脑叶、小脑、脑干、多部位及脑室,小脑出血总体比例多于脑干出血,占全部脑出血5.4%。在两组脑出血病例中,基底节区和脑叶出血所占比例无明显差异,均是脑出血最常见的出血部位,与青年组相比,小脑出血在中老年组较常见。3.出血病因:根据欧洲SMASH-U分型,高血压病是两组脑出血最常见的病因,但其在青年与中老年脑出血中所占比例有一定差异,该病因在中老年组更常见。不明原因脑出血和血管结构因素所致脑出血在青年脑出血中占有较大比例,而脑血管淀粉样病变是中老年人脑出血第二大常见病因。4.危险因素:高同型半胱胺酸血症、血脂异常在两组中的比列无显著差异(P0.05)。男性、吸烟史、饮酒史及家族史等危险因素在青年脑出血组更多见,而高血压病、糖尿病、冠心病及既往卒中病史在中老年脑出血组更常见,差异具有统计学意义(P0.05)。5.临床表现:肢体无力及言语不清比例在两组中无显著差别,而头痛、呕吐、意识障碍、肢体抽搐及小便失禁在两组中有差别,头痛及肢体抽搐在青年组常见,而其他临床表现在中老年组常见(P0.05)。6.影像学检查与结局:所有脑出血患者仅17.6%行脑血管检查,以颅脑MRA最多,其次是DSA检查和CTA检查。其中DSA检查以青年人居多,而CTA检查在中老年患者中多见。青年组住院期间死亡1例,中老年组住院期间死亡6例。结论及意义:脑出血病因及危险因素众多,临床表现多样,明确病因需更多影像学检查及实验室检测,青年与中老年脑出血在很多方面都存在较明显差异,分析两者之间的差异有助于指导各自临床治疗与预防。
[Abstract]:Background and objective: the incidence of spontaneous intracerebral haemorrhage (sICH) is second only to ischemic stroke, accounting for 20%-30% in acute cerebral vascular disease. It is the main cause of disability and death of patients. The cause and risk factors of.SICH are the main cause of disability and death. There are some differences between young and middle-aged brain hemorrhage in the etiology, risk factors, clinical manifestations, imaging examination and clinical outcomes. The active prevention and treatment of cerebral hemorrhage can effectively reduce the occurrence and recurrence of cerebral hemorrhage. The imaging diagnosis of cerebral hemorrhage is mainly brain CT (Co Mputed Tomography), followed by craniocerebral MRI (Magnetic Resonance Imaging). Magnetic resonance angiography (magnetic resonance angiography, MRA), CT angiography and digital subtraction angiography can help the diagnosis of the cause of cerebral hemorrhage, but current cerebral hemorrhage In recent years, there are many studies on the etiological classification and risk factors of ischemic stroke, but there are few studies on the etiological classification and risk factors of hemorrhagic cerebrovascular disease. The analysis of the etiology and risk factors is helpful to evaluate the patients, to choose effective treatment schemes, to judge the prognosis and to determine the prognosis. The difference of clinical manifestation is helpful to the early detection of cerebral hemorrhage and early intervention. The purpose of this study is to collect and analyze the clinical data of the patients with cerebral hemorrhage, summarize the common etiological factors and risk factors of cerebral hemorrhage, compare the differences between the two, and improve the overall understanding of the disease by clinicians and for the cerebral hemorrhage. A retrospective study of 442 patients with cerebral hemorrhage admitted in our department of Neurology from 01 months to December 2016 2011. Summarize the general data, including sex, age, bad lifestyle (such as smoking, drinking, drug abuse and drug abuse), past disease history (hypertension, diabetes, coronary heart disease). A history of hyperlipidemia and stroke, bleeding site, clinical manifestation and clinical outcome of discharge, and the results of laboratory tests (blood routine, blood lipid, blood sugar, liver and kidney function, coagulation function, virus series and rheumatic Series); imaging related materials (craniocerebral CT, MRI, MRA, MRV, CTA and DSA). The risk factors were different, and the patients were divided into two groups, 45 year old youth group and more than 45 years old and elderly group. SPSS21 was used in medical statistics analysis to compare the age and sex of the two groups of cerebral hemorrhage, bleeding site, common cause, risk factors, clinical manifestation and imaging examination. The results of the study: 1. age and sex of the 1. disease. Differences: the study found that the average age of cerebral hemorrhage in male women with early.45 years of cerebral hemorrhage accounted for all cases of cerebral hemorrhage in all patients with cerebral hemorrhage more than women, especially in the young cerebral hemorrhage group more than women, the difference was statistically significant (P0.05).2. bleeding site: the study found the basal ganglia area is brain. The most common part of blood, followed by lobes, cerebellum, brainstem, multiple parts and ventricles, was more than the brain stem hemorrhage, and the proportion of 5.4%. in all two groups of cerebral hemorrhage, the proportion of basal ganglia and cerebral lobes had no significant difference, which were the most common bleeding parts of cerebral hemorrhage. Compared with the young group, the cerebellar hemorrhage was in the middle of the brain. The most common cause of.3. hemorrhage in the elderly group: according to the European SMASH-U classification, hypertension is the most common cause of cerebral hemorrhage in the two groups, but the proportion in the young and middle aged brain hemorrhage is different, the cause is more common in the middle and old age group. The cerebral hemorrhage caused by unexplained cerebral hemorrhage and vascular structure factor occupies a more important part in the young brain hemorrhage. Large proportion, and cerebrovascular amyloid disease is the second most common cause of.4. in middle-aged and elderly patients with cerebral hemorrhage: high homocysteinemia and abnormal blood lipid in the two groups, there is no significant difference (P0.05). Men, smoking history, drinking history, family history and other risk factors are more common in the young cerebral hemorrhage group, and hypertension, diabetes, coronal heart The history of disease and previous stroke was more common in the middle aged and elderly cerebral hemorrhage group, and the difference was statistically significant (P0.05).5. clinical manifestations: there was no significant difference between the two groups, but headache, vomiting, disturbance of consciousness, limb convulsion and urinary incontinence were different in the two groups, and headache and limb convulsions were common in the young group, and the other The common (P0.05).6. imaging examination and outcome in the middle and old age group: all cerebral hemorrhage patients only 17.6% lines of cerebral vascular examination, with the most brain MRA, followed by DSA examination and CTA examination. Among them, the DSA examination was mostly in young people, and the CTA examination was more common in the middle aged and elderly patients. During the period of hospitalization, 1 cases were dead, and the middle and old age group died during hospitalization. There are 6 cases of death. Conclusion and significance: there are many causes and risk factors of cerebral hemorrhage and various clinical manifestations. More imaging examination and laboratory testing are needed to clear the cause of the disease. There are obvious differences in many aspects between young and middle-aged brain hemorrhage. Analysis of the difference between the two is helpful to guide the clinical treatment and prevention.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.34

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