【作者】 刘敬花；

【导师】 崔元孝；

【作者基本信息】 山东大学 ， 神经病学， 2009， 硕士

【摘要】 目的通过分析山东省立医院2005-2008年间脑出血(intracerebral hemorrhage,ICH)患者临床病历资料,探讨山东地区近期ICH流行病学、临床特点及预后危险因素,并根据临床分期提出整体化及个体化治疗方案。方法1.收集2005年1月至2008年12月在本院诊治且病历资料完整的460例患者,比较不同病程、年龄及性别间病因,发病特点,临床症状,体征,实验室检查,并发症和预后。2.年龄及病程分组方法:分为青年组(44岁以下),中年组(45-59岁),老年组(60-74岁),老老年(75岁以上)。将脑出血病程分为急性期(3天内),亚急性期(4-14天),恢复期(14天以上)。3.采用SPSS15.0统计软件进行统计分析和图形制作。计量资料采用((?)±S)表示,必要时转换为分类变量;计数资料用率或构成比表示;两组资料均数比较用t检验;多组资料均数比较用方差分析;计数资料比较用X~2检验,检验水准α=0.05。结果1.460例ICH中,男性共293例,女性167例,男女比例为1.75:1;高血压性脑出血组中男性227例,女性130例,男女比例为1.75:1;非高血压性脑出血组男性66例,女性37例,男女比例为1.78:1。高血压性脑出血年龄为58.18±13.02,非高血压性脑出血年龄为60.06±18.55。两者在年龄构成比之间有差异性(P＜0.05)。2.高血压性脑出血青年组男女发病比例12.75:1,中年组1.68:1,老年组1.04:1,老老年组1.63:1;非高血压性脑出血青年组男女发病比例1.4:1,中年组2.71:1,老年组1.17:1,老老年组2.86:1。3.四季发病构成:春季发病92例(20.00%),夏季73例(15.87%),秋季137例(29.78%),冬季158例(34.35%);四季发病构成经非参数检验有显著性差异。4.睡眠或清醒安静状态起病66例(14.35%),一般轻体力活动、用力或情绪激动起病394例(85.65%)。5.有高血压病或脑卒中家族史77例(21.57%),女23例,男54例。6.有吸烟史127例,男性125例,女性2例;有酗酒史122例,男119例,女3例。男性患者有饮酒吸烟史者均明显多于女性患者。7.在不同病程中,中性粒细胞及其百分比、血小板、血糖、凝血四项、低密度脂蛋白、血生化及尿素氮比较具有显著性差异(P＜0.05)。8.单因素分析中,发病后血压、有并发症、出血破入脑室对预后的的影响有显著性差异(P＜0.05)。9.经多元逐步回归分析,年龄、出血量、发病后意识障碍程度、并发症、体温升高是决定预后的主要因素。结论脑出血患者男性明显多于女性,高血压是最主要的危险因素,青年男性的发病率远远高于青年女性,年龄、出血量、发病后意识障碍程度、并发症、体温升高是决定预后的主要因素。更多还原

【Abstract】 [Objective]To analyze the clinical history of patients in Shandong Provincial Hospital affiliated to Shandong University during 2005-2008,so as to discuss the risk factor of prognosis,epidemiology,clinical characteristics in Shandong area,and introduce the holistic and individual therapy on the basis of clinical stage.[Method]1.According to the clinical history of 460 patients in our hospital,to compare the different courses with age and sex,characteristics,clinical symptoms,physical signs,laboratory examinations,complications and prognosis.2.We assigned to four age groups:young group(≤44),Middle-Age group(45-49), older age-group(60-74) and oldest age-group(≥75).Course stage was divided into three:acute stage(within 3 days),subacute stage(4-14days) and convalescence stage(exceed 14 days).3.Statistical analysis and graph manufacture were carried out with spss15 statistics software,measurement data were demonstrated by((?)±S),to transform into classified variable when necessary;numeration data were demonstrated by ratio or constituent ratio;to contrast the mean of two groups with t test;to contrast multi-group data with analysis of variance;to contrast numeration data with chi square test,statistical significance criterion wasα=0.05.【Results】1.Among 460 patients,male is 293 and female is 167,the male female ratio(M-F) is 1.75:1;M-F is 1.75:1 in the group of Hypertensive Intracerebral Hemorrhage (HICH),while M-F is 1.78:1 in the group of non- Hypertensive Intracerebral Hemorrhage(non-HICH).The age is 58.18±13.02 in the HICH and 60.06±18.55 in the non-HICH,the constituent ratio of two groups is variability(P＜0.05).2.In the HICH group,M-F is 12.75:1 among young group,1.68:1 among Middle-Age group,1.04:1 among older age-group and 1.63:1 among the oldest age-group;in the non-HICH group,M-F is 1.4:1 among young group,2.71:1 among Middle-Age group,1.17:1 among older age-group and 2.28:1 among oldest age-group.3.Season morbility:92 in spring(20.00%),73 in summer(15.87%),137 in autumn (29.78%),158 in winter(34.35%),Nonparameter test demonstrated significant difference of season morbility.4.The onset of ICH in the condition of sleep or resting state was 66(14.35%),394 (85.65%) were began in the condition of common physical work,exertion or excitement.5.The patients who have history of hypertensive disease or cerebral apoplexy were 77(21.57%),female is 23 while male is 54.6.127 patients have the history of smoking,include 2 female patients;122 patients have the history of alcohol abuse include 3 female patients.The male who have history of smoking or alcohol abuse is more than female.7.In the different courses of ICH,the comparison of heterophil granulocyte and its percentage,platelet,blood glucose,four items of the natural bleeding and blood coagulation,low density lipoprotein,blood biochemistry and urea nitrogen have significant difference(P＜0.05).8.Single-factor analysis indicated that blood pressure after illness,complications, haemorrhage broken into cerebral ventricle have significant difference to prognosis(P＜0.05).9.Stepwise regression analysis indicated that age,volume of blood,conscious disturbance after illness,complications and fervescence were major factor relate to prognosis.【Conclusions】Sex difference is obvious in the intracerebral hemorrhage patients,male is more than female.High blood pressure is the most major risk factor,the morbility in young male is far outclass young female.Age,volume of blood,conscious disturbance after illness,complications and fervescence were major factor related to prognosis.更多还原