本文選題：腦出血 + 病因　； 參考：《吉林大學(xué)》2017年碩士論文

【摘要】：研究背景:在中國(guó)各大疾病死亡原因中,腦血管病居于前列,疾病致殘率較高,給家庭和社會(huì)帶來(lái)極大負(fù)擔(dān)。腦出血發(fā)病率近幾年來(lái)增加幅度較大,特別是青年腦出血發(fā)病率呈增長(zhǎng)趨勢(shì)。腦出血病程中均可出現(xiàn)血腫擴(kuò)大,導(dǎo)致病情加重、預(yù)后不良。了解腦出血患者病因、危險(xiǎn)因素及血腫擴(kuò)大的相關(guān)因素,可為其預(yù)防和早期治療提供臨床依據(jù),進(jìn)而減少疾病負(fù)擔(dān)。目的:探討腦出血的病因、危險(xiǎn)因素及血腫擴(kuò)大相關(guān)因素,為臨床決策提供依據(jù)。方法:收集2015年1月~2016年12月在吉林大學(xué)第二醫(yī)院神經(jīng)內(nèi)、外科住院治療的274例急性腦出血患者的詳細(xì)病例資料,回顧性分析其流行病學(xué)特征、病史、臨床特征、實(shí)驗(yàn)室及影像學(xué)檢查,采用SPSS 22.0統(tǒng)計(jì)軟件進(jìn)行分析,討論其病因、危險(xiǎn)因素及血腫擴(kuò)大相關(guān)因素。結(jié)果:1.流行病學(xué)特征:274例患者中,男性166例,女性108例,各占60.6%和39.4%,男女性別比為1.54:1。發(fā)病平均年齡57.3±12.72歲,高發(fā)年齡在45~64歲年齡組,共158例,占72.3%;其次為65~74歲年齡組49例,占17.9%;31~44歲年齡組36例,占13.1%;年齡高于75歲者27例,占9.9%。腦出血發(fā)病率最高在1月份(占16.8%),秋冬兩季共161例,占58.7%,明顯高于夏季(44例,占16.1%)。2.病因:高血壓腦出血152例,占55.5%;顱內(nèi)動(dòng)脈瘤22例,占8.0%;煙霧病8例,占2.9%;血管畸形4例,血液病2例,瘤卒中1例,抗血小板聚集藥物應(yīng)用史10例,妊娠1例。3.危險(xiǎn)因素:單因素分析顯示,與健康對(duì)照組相比,腦出血組患者飲酒、高血壓、腦梗死病史、APTT、TG、LDL-C、HDL-C、血糖、Hcy、Cys C及超敏C反應(yīng)蛋白等差異有統(tǒng)計(jì)學(xué)意義(P0.05),Logistic回歸分析顯示腦梗死病史、高血壓及血清高水平LDL-C為腦出血的獨(dú)立危險(xiǎn)因素(P0.05)。4.血腫擴(kuò)大相關(guān)因素:單因素分析顯示,與血腫未擴(kuò)大組相比,血腫擴(kuò)大組患者的發(fā)病距首次行頭部CT檢查時(shí)間、入院GCS評(píng)分、入院NIHSS評(píng)分和血清白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞計(jì)數(shù)、PT、APTT、TG、HDL-C、APO-A1、血糖及Cys C水平差異有統(tǒng)計(jì)學(xué)意義(P0.05)。Logistic回歸分析顯示較短的發(fā)病距首次行頭部CT檢查時(shí)間、低入院GCS評(píng)分、高入院NIHSS評(píng)分、血清高水平HDL-C及血糖為腦出血急性期血腫擴(kuò)大獨(dú)立危險(xiǎn)因素(P0.05)。結(jié)論:1.腦出血發(fā)病男性多于女性,男女性別比1.54:1,中老年患者發(fā)病率較高,秋冬季節(jié)為腦出血高發(fā)季節(jié)。2.腦出血病因?yàn)楦哐獕�、�?dòng)脈瘤、煙霧病、血管畸形、血液病、瘤卒中、抗血小板聚集藥物應(yīng)用、妊娠等;腦梗死病史、高血壓及血清高水平LDL-C為腦出血的獨(dú)立危險(xiǎn)因素。3.腦出血早期血腫擴(kuò)大的危險(xiǎn)因素為:較短的發(fā)病距首次行頭部CT檢查時(shí)間、低入院GCS評(píng)分、高入院NIHSS評(píng)分、血清高水平HDL-C及血糖。
[Abstract]:Background: cerebrovascular diseases are among the leading causes of death in China. The incidence of intracerebral hemorrhage (ICH) has increased greatly in recent years, especially in young people. Hematoma enlargement can occur in the course of intracerebral hemorrhage, leading to aggravation of the disease and poor prognosis. Understanding the etiology, risk factors and related factors of hematoma enlargement in patients with intracerebral hemorrhage can provide clinical basis for its prevention and early treatment, and then reduce the burden of disease. Objective: to explore the etiology, risk factors and hematoma enlargement related factors of intracerebral hemorrhage. Methods: 274 cases of acute intracerebral hemorrhage were collected from January 2015 to December 2016 in the second Hospital of Jilin University, and their epidemiological characteristics, history and clinical features were analyzed retrospectively. The etiology, risk factors and related factors of hematoma enlargement were analyzed by SPSS 22. 0 statistical software. The result is 1: 1. Of the 274 patients, 166 were males and 108 were females, accounting for 60.6% and 39.4%, respectively, with a sex ratio of 1.54: 1. The average age of onset was 57.3 鹵12.72 years old, the high incidence age group was 45 ~ 64 years old (158 cases, 72.3%), the second was 65 74 years old (49 cases), accounting for 17.9% (3144 years), 36 cases (13.1%), and 27 cases (9.9B) in the age group over 75 years old. The highest incidence of intracerebral hemorrhage was in January (16.8%) and in autumn and winter (161 cases), accounting for 58.7 cases, which was significantly higher than that in summer (16.1%). Causes: 152 cases of hypertensive cerebral hemorrhage (55.5%), 22 cases of intracranial aneurysms (8.0%), 8 cases of moyamoya disease (2.9%), 4 cases of vascular malformation, 2 cases of hematologic diseases, 1 case of tumor stroke, 10 cases of antiplatelet aggregation drug use history, 1 case of pregnancy. Risk factors: univariate analysis showed that there were significant differences in alcohol consumption, hypertension, history of cerebral infarction, HDL-C, HcyCys C and hypersensitive C-reactive protein between patients with cerebral hemorrhage and healthy controls (P 0.05 logistic regression analysis). Hypertension and high serum LDL-C were independent risk factors for intracerebral hemorrhage. Factors related to hematoma enlargement: univariate analysis showed that the first time of head CT examination, admission GCS score, admission NIHSS score and serum white blood cell count were observed in the hematoma enlargement group compared with the unenlarged hematoma group. There were significant differences in plasma glucose and Cys C levels between the two groups (P < 0.05). Logistic regression analysis showed that the first time of head CT examination, low admission GCS score, and high admission NIHSS score were shorter than those before onset. High level of serum HDL-C and blood glucose were independent risk factors of hematoma enlargement in acute stage of intracerebral hemorrhage (P 0.05). Conclusion 1. The incidence of intracerebral hemorrhage was higher in male than in female, the ratio of male to female was 1.54: 1. The incidence of intracerebral hemorrhage was higher in middle-aged and elderly patients than in female, and the incidence of intracerebral hemorrhage was higher in autumn and winter. Cerebral hemorrhage due to hypertension, aneurysm, moyamoya disease, vascular malformation, hematopathy, stroke, antiplatelet aggregation drug use, pregnancy, history of cerebral infarction, hypertension and high serum LDL-C are the independent risk factors of cerebral hemorrhage. The risk factors of hematoma enlargement in early stage of intracerebral hemorrhage were as follows: short time of head CT examination, low admission GCS score, high admission NIHSS score, high serum HDL-C and blood glucose.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R743.34

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