四川省人民医院10年住院神经外科疾病构成特点及预后分析
发布时间：2018-09-17 18:43
【摘要】：目的:基于四川省人民医院神经外科10年住院数据,分析近十年住院神经外科疾病的流行病学特点、疾病预后及演变情况。以期为深入研究神经外科疾病提供参考。方法:利用四川省人民医院住院病历系统,收集四川省人民医院神经外科2007年1月1日至2016年12月31日10年间共收治23,562例住院病人的资料及相关数据,统计分析神经外科住院各类疾病的患病情况(疾病构成比)、人群分布(性别、年龄),手术及并发症、合并症、病死率和出院预后,及这些特征随时间的变化情况。结果:(1)疾病构成及演变:颅脑损伤、脑血管病、颅脑肿瘤仍为神经外科的三大主要疾病,10年内总的构成顺序及2014年前每年其构成位序分别是颅脑损伤、脑血管病、颅脑肿瘤;2014年开始每年的构成位序逐渐发生了变化,2014年脑血管病(27.47%)超过颅脑损伤(26.60%)成为神经外科第一大疾病,2015年颅脑肿瘤(23.86%)逐渐成为第二大主要疾病,颅脑外伤构成比仅为23.72%,此后神经外科三大疾病构成位序为脑血管疾病、颅脑肿瘤、颅脑外伤。(2)住院病死率:总病死率为5.94%,各病种的病死率逐年下降,以颅脑损伤和脑血管疾病最为明显,颅脑损伤病死率由2007年的11.93%降至2016年的3.61%,脑血管疾病病死率由2007年的15.87%降至2016年的4.72%。(3)疾病的性别构成:男性住院人数高于女性(1.43:1);颅脑损伤多发生在男性(2.94:1);颅内动脉瘤好发于40岁以上女性(0.55:1);颅内常见的恶性肿瘤如胶质母细胞瘤(1.51:1)、脑转移瘤(1.49:1)好发于男性;颅内常见的良性肿瘤如脑膜瘤(0.46:1),神经鞘瘤(0.55:1),垂体瘤(0.88:1)则好发于女性;三叉神经痛(0.57:1)及面肌痉挛(0.53:1)均好发于女性。(4)疾病的年龄分布:颅脑损伤主要在青年及中老年,中年比率最高(38.41%),慢性硬膜下血肿好发于60岁以上人群(74.24%),脑血管疾病集中在中老年组(83.47%),颅脑肿瘤主要集中在中青年(79.54%),79.38%的GBM发生于40岁以上人群,三叉神经痛(97.18%)及面肌痉挛(86.53%)均好发于40岁人群。(5)疾病的发病形式:88.04%自发性SAH源于颅内动脉瘤,67.25%颅内动脉瘤患者表现为出血,4.29%颅内动脉瘤患者伴随动眼神经麻痹;46.88%的脑动静脉畸形患者因出血而就诊。(6)专科手术及术后颅内感染:除颅脑损伤外其它各大病种年专科手术量不断增长,但术后颅内感染发生率也逐渐上升。(7)合并症及影响预后因素:高血压为神经外科疾病中最普遍的合并症。年龄升高(OR=0.86,95%CI:0.84-0.91)、高血压(OR=0.91,95%CI:0.83-0.99)、肺部感染(OR=0.72,95%CI:0.64-0.80),合并症数量(除高血压、肺部感染外的)(OR=0.89,95%CI:0.87-0.19)是患者死亡和疾病好转或治愈率下降的危险因素。结论:近10年四川省人民医院神经外科住院收治病人资料提示:(1)脑血管疾病、颅脑肿瘤已经超越颅脑损伤分别成为威胁人群健康的第一大与第二大神经外科疾病,而颅脑损伤逐渐成为第三大神经外科疾病。(2)住院病人中的男性多于女性,41-65岁病人比例最高,不同病种病人的年龄性别分布有差异(3)各类疾病的病死率呈现逐年下降趋势,好转率或有效率呈逐年上升的趋势,但脑血管疾病依然为神经外科致死率最高、好转率最低的疾病,需要进一步加强对脑血管疾病治疗的研究。(4)应采取综合措施来预防患者术后颅内感染等并发症的发生,降低病死病残率。(5)男性、年龄升高、合并高血压、肺部感染、合并症数量增多(除高血压、肺部感染外的)均为影响治疗效果的危险因素。
[Abstract]:OBJECTIVE: To analyze the epidemiological characteristics, prognosis and evolution of neurosurgical diseases in Sichuan People's Hospital in the past ten years, based on the data of neurosurgery in Sichuan Province People's Hospital for 10 years. Data and related data of 23,562 hospitalized patients from January 1, 2007 to December 31, 2016 were analyzed. The prevalence of various diseases (disease composition ratio), population distribution (sex, age), operation and complications, complications, mortality and discharge prognosis, and the changes of these characteristics with time were analyzed. (1) Disease composition and evolution: craniocerebral injury, cerebrovascular disease, and craniocerebral tumors are still the three major diseases in neurosurgery. The overall composition sequence in 10 years and the annual composition sequence before 2014 are craniocerebral injury, cerebrovascular disease, and Craniocerebral Tumor respectively. The composition sequence of each year has gradually changed since 2014, and cerebrovascular disease (27.47%) in 2014 has exceeded that in 2014. Transcranial brain injury (26.60%) became the first major disease in neurosurgery, and craniocerebral tumors (23.86%) gradually became the second major disease in 2015. The proportion of craniocerebral trauma was only 23.72%. Since then, the three major diseases in neurosurgery were cerebrovascular diseases, craniocerebral tumors and craniocerebral trauma. (2) In-hospital mortality: the total mortality rate was 5.94%, and the mortality of various diseases was only 23.72%. The mortality of craniocerebral injury decreased from 11.93% in 2007 to 3.61% in 2016, and the mortality of cerebrovascular disease decreased from 15.87% in 2007 to 4.72% in 2016. Aneurysms are predominant in women over 40 years old (0.55:1); common intracranial malignancies such as glioblastoma (1.51:1), brain metastases (1.49:1) are predominant in men; benign intracranial tumors such as meningioma (0.46:1), neurilemmoma (0.55:1), pituitary adenoma (0.88:1) are predominant in women; trigeminal neuralgia (0.57:1) and facial spasm (0.53:1) are predominant. (4) Age distribution of the disease: craniocerebral injury mainly occurred in young people and middle-aged and old people, the highest rate of middle-aged (38.41%), chronic subdural hematoma predominantly occurred in people over 60 years old (74.24%), cerebrovascular diseases concentrated in the middle-aged and old group (83.47%), craniocerebral tumors mainly concentrated in young and middle-aged (79.54%), 79.38% of GBM occurred in people over 40 years old, trigeminal nerve. Pain (97.18%) and hemifacial spasm (86.53%) were predisposed to 40-year-old people. (5) Pathogenesis of the disease: 88.04% of spontaneous SAH originated from intracranial aneurysms, 67.25% of patients with intracranial aneurysms showed bleeding, 4.29% of patients with intracranial aneurysms accompanied by oculomotor nerve paralysis, 46.88% of patients with cerebral arteriovenous malformations were treated for bleeding. (6) Specialized surgery and postoperative intracranial aneurysms. Infection: Except for craniocerebral injury, the number of specialized operations increased year by year, but the incidence of intracranial infection increased gradually after operation. (7) Complications and prognostic factors: hypertension was the most common complication in neurosurgical diseases. Age increased (OR = 0.86, 95% CI: 0.84-0.91), hypertension (OR = 0.91, 95% CI: 0.83-0.99), pulmonary infection (OR = 0.83-0.99). 72,95% CI: 0.64-0.80), the number of complications (except hypertension and pulmonary infection) (OR = 0.89,95% CI: 0.87-0.19) were the risk factors of death, improvement of disease or decrease of cure rate. (2) Males were more than females, and the proportion of patients aged 41-65 was the highest. The age and sex distribution of patients with different diseases were different. (3) The mortality of various diseases showed a downward trend year by year, and the improvement rate was higher. However, cerebrovascular diseases are still the diseases with the highest fatality rate and the lowest improvement rate in neurosurgery. It is necessary to further strengthen the research on the treatment of cerebrovascular diseases. (4) Comprehensive measures should be taken to prevent the occurrence of postoperative intracranial infection and other complications, and to reduce the mortality and disability rate. (5) Male, age increased, combined. Hypertension, pulmonary infection, and increased number of complications (except hypertension and pulmonary infection) are all risk factors affecting the outcome of treatment.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651
本文编号：2246783
[Abstract]:OBJECTIVE: To analyze the epidemiological characteristics, prognosis and evolution of neurosurgical diseases in Sichuan People's Hospital in the past ten years, based on the data of neurosurgery in Sichuan Province People's Hospital for 10 years. Data and related data of 23,562 hospitalized patients from January 1, 2007 to December 31, 2016 were analyzed. The prevalence of various diseases (disease composition ratio), population distribution (sex, age), operation and complications, complications, mortality and discharge prognosis, and the changes of these characteristics with time were analyzed. (1) Disease composition and evolution: craniocerebral injury, cerebrovascular disease, and craniocerebral tumors are still the three major diseases in neurosurgery. The overall composition sequence in 10 years and the annual composition sequence before 2014 are craniocerebral injury, cerebrovascular disease, and Craniocerebral Tumor respectively. The composition sequence of each year has gradually changed since 2014, and cerebrovascular disease (27.47%) in 2014 has exceeded that in 2014. Transcranial brain injury (26.60%) became the first major disease in neurosurgery, and craniocerebral tumors (23.86%) gradually became the second major disease in 2015. The proportion of craniocerebral trauma was only 23.72%. Since then, the three major diseases in neurosurgery were cerebrovascular diseases, craniocerebral tumors and craniocerebral trauma. (2) In-hospital mortality: the total mortality rate was 5.94%, and the mortality of various diseases was only 23.72%. The mortality of craniocerebral injury decreased from 11.93% in 2007 to 3.61% in 2016, and the mortality of cerebrovascular disease decreased from 15.87% in 2007 to 4.72% in 2016. Aneurysms are predominant in women over 40 years old (0.55:1); common intracranial malignancies such as glioblastoma (1.51:1), brain metastases (1.49:1) are predominant in men; benign intracranial tumors such as meningioma (0.46:1), neurilemmoma (0.55:1), pituitary adenoma (0.88:1) are predominant in women; trigeminal neuralgia (0.57:1) and facial spasm (0.53:1) are predominant. (4) Age distribution of the disease: craniocerebral injury mainly occurred in young people and middle-aged and old people, the highest rate of middle-aged (38.41%), chronic subdural hematoma predominantly occurred in people over 60 years old (74.24%), cerebrovascular diseases concentrated in the middle-aged and old group (83.47%), craniocerebral tumors mainly concentrated in young and middle-aged (79.54%), 79.38% of GBM occurred in people over 40 years old, trigeminal nerve. Pain (97.18%) and hemifacial spasm (86.53%) were predisposed to 40-year-old people. (5) Pathogenesis of the disease: 88.04% of spontaneous SAH originated from intracranial aneurysms, 67.25% of patients with intracranial aneurysms showed bleeding, 4.29% of patients with intracranial aneurysms accompanied by oculomotor nerve paralysis, 46.88% of patients with cerebral arteriovenous malformations were treated for bleeding. (6) Specialized surgery and postoperative intracranial aneurysms. Infection: Except for craniocerebral injury, the number of specialized operations increased year by year, but the incidence of intracranial infection increased gradually after operation. (7) Complications and prognostic factors: hypertension was the most common complication in neurosurgical diseases. Age increased (OR = 0.86, 95% CI: 0.84-0.91), hypertension (OR = 0.91, 95% CI: 0.83-0.99), pulmonary infection (OR = 0.83-0.99). 72,95% CI: 0.64-0.80), the number of complications (except hypertension and pulmonary infection) (OR = 0.89,95% CI: 0.87-0.19) were the risk factors of death, improvement of disease or decrease of cure rate. (2) Males were more than females, and the proportion of patients aged 41-65 was the highest. The age and sex distribution of patients with different diseases were different. (3) The mortality of various diseases showed a downward trend year by year, and the improvement rate was higher. However, cerebrovascular diseases are still the diseases with the highest fatality rate and the lowest improvement rate in neurosurgery. It is necessary to further strengthen the research on the treatment of cerebrovascular diseases. (4) Comprehensive measures should be taken to prevent the occurrence of postoperative intracranial infection and other complications, and to reduce the mortality and disability rate. (5) Male, age increased, combined. Hypertension, pulmonary infection, and increased number of complications (except hypertension and pulmonary infection) are all risk factors affecting the outcome of treatment.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R651
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