不同部位脑出血的危险因素及恢复期记忆障碍的研究

发布时间：2018-07-09 20:22

本文选题：脑出血 + 危险因素　；参考：《山东大学》2014年硕士论文

【摘要】：脑出血是严重危害人类健康的一种多发病和常见病。除躯体功能障碍外,包括记忆在内的认知方面的病残是影响脑出血后生存质量的重要因素,因此脑出血的预防和治疗一直是神经科学界关注的焦点。然而,不同部位脑出血的危险因素和认知损害特点目前尚不明了,这影响了脑出血的有效防治。为此,本研究旨在探讨不同部位脑出血危险因素的异同和脑出血恢复期记忆成分受损特点。第一部分不同部位脑出血危险因素的临床研究目的探讨不同部位脑出血危险因素的异同。研究对象和方法选取2012-2014年在神经内科门诊就诊及住院的脑出血患者97例,其中基底节出血36例,丘脑出血36例,脑叶出血25例及同期健康体检者100例。调查收集人口学资料、疾病史、生活习惯及血清甘油三酯(TG),总胆固醇(TC),高密度脂蛋白胆固醇(HDL-C),低密度脂蛋白胆固醇(LDL-C)指标。结果 1.脑出血危险因素分析 1.1分类变量单因素分析吸烟、饮酒、高血压为出血性脑卒中的危险因素,与对照组比较差异有统计学意义(P0.05)。性别、糖尿病、冠心病脑出血组与对照组相比,差异无统计学意义(P0.05)。 1.2连续变量单因素分析SBP、DBP为出血性脑卒中的危险因素,与对照组比较差异有统计学意义(P0.05)。HDL、TC为脑出血的保护性因素(P0.05)。年龄、LDL、TG脑出血组与对照组相比,差异无统计学意义(P0.05)。 1.3多因素logistic回归分析饮酒、高血压、LDL是出血性脑卒中的独立危险因素1, P0.05), TC为脑出血的保护性因素(OR=0.25,P=0.000)。 2.不同部位脑出血危险因素分析 2.1分类变量单因素分析吸烟、饮酒、高血压为基底节与丘脑出血的危险因素,与对照组比较差异有统计学意义(P0.05)。吸烟、饮酒是脑叶出血的危险因素,性别、糖尿病、冠心病在对照组与脑出血亚型组,差异均无统计学意义(P0.05)。 2.2连续变量单因素分析年龄、SBP、DBP为基底节出血性脑卒中的危险因素,SBP、DBP为丘脑出血与脑叶出血性脑卒中的危险因素,与对照组比较差异有统计学意义(P0.05)。HDL是基底节出血与丘脑出血的保护性因素(P0.05),TC是基底节出血与脑叶出血的保护性因素(P0.05)。TG在对照组与脑出血亚型组,差异均无统计学意义(P0.05)。 2.3不同部位脑出血危险因素的多因素分析高血压、LDL是基底节脑出血的危险因素,TC是基底节脑出血的保护性因素。饮酒、高血压是丘脑出血的危险因素。饮酒是脑叶出血的危险因素,TC是脑叶出血的保护性因素。结论饮酒、高血压是脑出血的独立危险因素,TC是脑出血的保护性因素。不同部位的脑出血其危险因素不同。高血压是基底节、丘脑深部脑出血的危险因素,饮酒是丘脑、脑叶出血的危险因素。第二部分不同部位脑出血恢复期记忆障碍的临床研究目的探讨不同部位的脑出血记忆损害特点,为及早识别和干预脑出血后的记忆损害,延缓血管性痴呆(VD)的发生提供依据。研究对象和方法选择25例基底节脑出血、10例丘脑出血患者和50名健康查体者,应用韦氏记忆量表(WMS)、韦氏成人智力量表(WAIS-RC)词汇分测验和Rey听觉词语学习测验工具,进行不同记忆成分的检测。分别比较基底节脑出血、丘脑出血患者与正常对照组,基底节脑出血与丘脑出血以及左右基底节脑出血之间的测量结果。3个组别的性别、年龄、受教育程度比较差异无统计学意义。结果基底节脑出血在短时记忆(1-100、100-1、累加、图片回忆、视觉再认、视觉再生、联想学习、触觉记忆)、工作记忆(倒背)、语义记忆(词汇测试)、延迟回忆(短延迟回忆、长延迟回忆)等记忆指标上与正常对照组的差异有统计学意义(P0.05)。丘脑出血在长时记忆(定向)、短时记忆(1-100、100-1、累加、图片回忆、视觉再认、视觉再生、联想学习、触觉记忆)、工作记忆(倒背)、语义记忆(词汇测试)、延迟回忆(短延迟回忆、长延迟回忆)等记忆指标上与正常对照组的差异有统计学意义(P0.05)。左侧基底节脑出血联想学习明显低于右侧基底节脑出血(P0.05),视觉再认右侧基底节脑出血明显低于左侧,差异具有显著性(P0.01),而语义记忆左右两侧基底节脑出血差异无统计学意义(P0.05)。结论脑出血恢复期仍存在记忆功能障碍,不同部位的脑出血记忆成分受损不同。
[Abstract]:Cerebral hemorrhage is a kind of multi - morbidity and common diseases which seriously harm human health . In addition to somatic dysfunction , cognitive impairment including memory is an important factor affecting the quality of life after intracerebral hemorrhage . Therefore , the prevention and treatment of cerebral hemorrhage has been the focus of neuroscientific community . However , the risk factors and cognitive impairment characteristics of cerebral hemorrhage in different parts are still unknown , which affects the effective prevention and treatment of cerebral hemorrhage .

Clinical study on risk factors of intracerebral hemorrhage in different parts of the first part

Objective To explore the similarities and differences of risk factors of intracerebral hemorrhage in different parts .

Methods The subjects and methods were selected for 97 cases of cerebral hemorrhage patients who visited and were hospitalized from 2012 to 2014 , including 36 cases of basal ganglia hemorrhage , 36 cases of thalamus hemorrhage , 25 cases of cerebral lobe hemorrhage and 100 cases of healthy physical examination in the same period . The data of population , history of diseases , living habits and serum triglyceride ( TG ) , total cholesterol ( TC ) , high density lipoprotein cholesterol ( HDL - C ) and low density lipoprotein cholesterol ( LDL - C ) were collected .

Results

1 . Analysis of risk factors of cerebral hemorrhage

1 . The risk factors of smoking , alcohol consumption and hypertension were analyzed by the single factor of categorical variables . There was no significant difference compared with the control group ( P0.05 ) . There was no significant difference in sex , diabetes and coronary heart disease cerebral hemorrhage group compared with the control group ( P0.05 ) .

1.2 The risk factors of SBP and DBP for hemorrhagic stroke were analyzed by single factor of continuous variables ( P0.05 ) . HDL and TC were protective factors of cerebral hemorrhage ( P0.05 ) .

1.3 Multivariate logistic regression analysis showed that alcohol intake , hypertension and LDL were independent risk factors of hemorrhagic stroke ( 1 , P0.05 ) , TC was protective factor of cerebral hemorrhage ( OR = 0.25 , P = 0.000 ) .

2 . Analysis of risk factors of cerebral hemorrhage in different parts

2.1 The risk factors of smoking , alcohol consumption and hypertension were the risk factors of basal ganglia and thalamus hemorrhage compared with the control group ( P0.05 ) . There was no significant difference between the control group and the cerebral hemorrhage subtype group ( P0.05 ) .

2 . The risk factors , SBP and DBP were the risk factors of hemorrhagic stroke in basal ganglia , SBP and DBP were the risk factors of hemorrhagic stroke in basal ganglia ( P0.05 ) . HDL was the protective factor of basal ganglia hemorrhage and cerebral hemorrhage ( P0.05 ) .

2.3 Multi - factor analysis of risk factors of cerebral hemorrhage in different parts is a risk factor for cerebral hemorrhage in basal ganglia . TC is a protective factor for cerebral hemorrhage in basal ganglia . Drinking is a risk factor for cerebral hemorrhage . Drinking is a risk factor for cerebral hemorrhage . TC is a protective factor for cerebral hemorrhage .

Conclusion Alcohol consumption and hypertension are independent risk factors of cerebral hemorrhage , TC is the protective factor of cerebral hemorrhage . The risk factors of cerebral hemorrhage in different parts are different . Hypertension is a risk factor for basal ganglia and deep cerebral hemorrhage in thalamus . Drinking is a risk factor for thalamus and cerebral hemorrhage .

A clinical study on the memory impairment of different parts of cerebral hemorrhage in different parts of the second part

Objective To explore the characteristics of cerebral hemorrhage memory impairment at different sites , and to provide a basis for early identification and intervention of memory impairment after cerebral hemorrhage and to delay the occurrence of vascular dementia ( VD ) .

Twenty - five cases of basal ganglia hemorrhage , 10 cases of thalamus hemorrhage and 50 healthy controls were selected by the study object and method . The results were compared between the cerebral hemorrhage in basal ganglia , the Wechsler Adult Intelligence Scale ( WAIS - RC ) vocabulary test and the Rey auditory word learning test tool . The results were compared between the basal ganglia hemorrhage and the thalamus hemorrhage and the cerebral hemorrhage in the left and right basal ganglia .

Results The memory indexes of basal ganglia hemorrhage were significantly lower than those in the normal control group ( P0.05 ) . The cerebral hemorrhage in the left basal ganglia was significantly lower than that in the normal control group ( P0.05 ) . The cerebral hemorrhage in the left basal ganglia was significantly lower than that in the right basal ganglia ( P0.05 ) .

Conclusion There is still memory dysfunction in the recovery period of cerebral hemorrhage , and the memory impairment of cerebral hemorrhage in different parts is different .
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.34

【参考文献】