本文選題：危險因素　切入點：腦出血　出處：《瀘州醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討青年和中老年患者腦出血的危險因素及預(yù)后的相關(guān)性。資料與方法：1、前瞻性登記2012年6月1日-2013年11月30日在四川省人民醫(yī)院神經(jīng)內(nèi)科、神經(jīng)外科及康復(fù)科連續(xù)入院的所有發(fā)生自發(fā)性腦出血患者348例。納入患者均符合美國成人自發(fā)性腦出血治療指南2010年的診斷標(biāo)準(zhǔn)。動態(tài)觀察患者住院期間情況及全面收集可能與自發(fā)性腦出血相關(guān)的臨床及實驗室檢查數(shù)據(jù)。2、將所有登記在冊的腦出血患者按年齡分為＜45歲的青年組和≥45歲的中老年組。3、患者出院后3個月、6個月末進(jìn)行電話隨訪，，了解預(yù)后情況。電話隨訪主要內(nèi)容：1)患者生存或死亡狀態(tài)；2)腦卒中的復(fù)發(fā)情況；3）服藥情況；4）有無殘疾。殘疾判定采用改良Rankin評分量表(Modified RankinScale，MRS)。MRS大于等于3分為不良預(yù)后即死亡/殘疾（死亡與殘疾的總和），小于3分為預(yù)后良好即生活自理。主要判效指標(biāo)：（1）隨訪期末的死亡率；（2）隨訪期末的不良結(jié)局（即死亡/殘疾）率。4、使用SPSS17.0軟件包對數(shù)據(jù)進(jìn)行統(tǒng)計分析，計量資料采用均數(shù)±標(biāo)準(zhǔn)差（x±s）或中位數(shù)描述。兩組計量資料相比較，若服從正態(tài)分布，采用T檢驗，若非正態(tài)分布，采用秩和檢驗。計數(shù)資料的兩組比較，采用卡方檢驗。當(dāng)四格表中出現(xiàn)理論頻數(shù)（theoretical frequency，T）小于5時，采用四格表確切概率法。5、對可能影響患者發(fā)病后3月、6月死亡及死亡/殘疾的各種危險因素進(jìn)行單因素分析，對P≤0.10的危險因素進(jìn)行多因素分析，校正混雜因素，確定影響預(yù)后的獨立危險因素。 結(jié)果：1、本研究共納入符合標(biāo)準(zhǔn)的病例308例，其中青年組腦出血患者46（14.9%）例，中老年組腦出血患者262（85.1%）例。青年組年齡范圍為21-44歲，平均年齡38.8±7.1歲，其中男性36（78.3%）例，女性10(21.7%)例。中老年組年齡范圍為45-90歲，平均年齡66.6±11.5歲，其中男性165（63.0%）例，女性97(37.0%)例。經(jīng)X2檢驗，P＜0.05，兩組男性發(fā)病均多于女性，差異有統(tǒng)計學(xué)意義。2、住院期間青年組腦出血共死亡2人（8.7%），出血部位分別位于腦干及多灶性出血。中老年腦出血患者住院期間共死亡28人（10.7%)，出血部位分別位于腦干、基底節(jié)、丘腦及多灶性出血。3、高血壓是兩組腦出血患者發(fā)病最重要的危險因素，此外，糖尿病及高脂血癥是中老年腦出血發(fā)病的主要危險因素,而煙酒史及腦血管畸形是青年腦出血主要的危險因素。影響兩組腦出血患者的危險因素中性別、糖尿病、高血壓及卒中史差異有統(tǒng)計學(xué)意義，兩組患者住院期間死亡/殘疾之間差異有統(tǒng)計學(xué)意義。4、入院病情嚴(yán)重程度（入院時NIHSS入院評分）是患者3月、6月末死亡的獨立影響因素。5、組別及NIHSS評分是患者3月、6月末死亡/殘疾的獨立危險因素，入院隨機血糖是患者6月末的死亡/殘疾獨立危險因素。 結(jié)論：1、控制好血壓外，中老年人還應(yīng)控制好血糖及血脂，青年人應(yīng)注重養(yǎng)成戒煙、限酒等良好的生活方式，可以有效降低腦出血的發(fā)生，改善腦出血預(yù)后。2、發(fā)生在腦干部位的腦出血死亡率高，發(fā)生在腦干、丘腦部位的患者預(yù)后差。3、年齡45歲以上的中老年人，入院時隨機血糖明顯升高，神經(jīng)功能缺損癥狀明顯者，出現(xiàn)不良結(jié)局（殘疾或死亡）的可能性越大。
[Abstract]:Objective: To investigate the correlation between the risk factors and prognosis in young and elderly patients with cerebral hemorrhage. Materials and methods: 1 prospective registration June 1, 2012 -2013 year in November 30th in the neurology department of Sichuan Provincial People's Hospital, Department of neurosurgery and rehabilitation of all consecutive patients with spontaneous intracerebral hemorrhage in 348 cases. Patients were accorded with the diagnostic standard guidelines for the treatment of adults in the United States in 2010 spontaneous cerebral hemorrhage. Dynamic observation of patients during hospitalization and comprehensive collection of clinical and laboratory data of.2 may be associated with spontaneous intracerebral hemorrhage, all registered patients with cerebral hemorrhage were divided into less than 45 year old youth group and over 45 years old group.3, 3 months after discharge from hospital, 6 at the end of a telephone follow-up was conducted to understand the prognosis. The main contents of telephone follow-up: 1) patient survival or death; 2) the recurrence of stroke; 3) pill 4); there is no disability. Disability was determined by modified Rankin scale (Modified, RankinScale, MRS).MRS is greater than or equal to 3 points for the poor prognosis of death / disability (sum of death and disability), less than 3 points for the good prognosis is living. The main criterion: (1) at the end of follow-up mortality; (2) the adverse outcome at the end of follow-up (i.e. the death / disability rate of.4), SPSS17.0 software package was used for statistical analysis of the data, the measurement data using the mean and standard deviation (x + s) or median description. Two groups of measurement data are compared, if the normal distribution, using T test, it is the normal distribution, Wilcoxon test. The comparison between the two groups of count data, using the chi square test. When the four tables appear in the theoretical frequency (theoretical frequency T) is less than 5, using four exact method.5, may impact on the patients after March June, death and death / disability all The risk factors were analyzed by univariate analysis, multivariate analysis of risk factors of P is less than or equal to 0.10, adjusted for confounding factors, determine the independent prognostic factors.
緇撴灉錛

本文編號：1639867