本文選題：急性重癥腦血管病 + 腦死亡��； 參考：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：分析急性重癥腦血管病死亡病例的分布及臨床特征，探討腦死亡與心肺死亡發(fā)生、時間差異，以期為降低急性重癥腦血管病病死率、了解腦死亡提供參考。 方法：回顧性分析，收集大連醫(yī)科大學(xué)附屬第一醫(yī)院神經(jīng)ICU、中心ICU以及急診ICU病房2010年01月至2013年06月急性重癥腦血管病死亡病例共605例。分析605例急性重癥腦血管病死亡病例的一般情況、生存時間、臨床特征、死亡原因等臨床資料。通過歸納整理605例急性重癥腦血管病死亡患者的意識狀態(tài)、腦干反射情況、GCS評分、FOUR評分，收集符合臨近腦死亡和臨床腦死亡標準的病例，分別分析臨近腦死亡、臨床腦死亡轉(zhuǎn)歸、發(fā)生時間，，以及臨近腦死亡至心肺死亡、臨近腦死亡至臨床腦死亡的時間分布情況。 采用SPSS17.0統(tǒng)計軟件進行數(shù)據(jù)分析。使用Frequencies、Crosstabs對分類變量的頻數(shù)、構(gòu)成比進行統(tǒng)計分析，使用Kaplan-Meier法和Log Rank檢驗法對事件發(fā)生時間進行生存分析。以P＜0.05為差異有統(tǒng)計學(xué)意義。 結(jié)果： 1.605例急性重癥腦血管病男性372例，女性233例，男女比例1.6：1。男性平均年齡（65.11±14.885）歲，女性平均年齡（71.75±13.264）歲；44歲以下39例，男女比例4.6：1；45-59歲154例，男女比例3.1：1；60-74歲169例，男女比例1.4：1；75歲以上243例，男女比例1.1：1。 2.605例急性重癥腦血管病患者缺血性腦卒中252例（41.7%），男性142例（56.3%），女性110例（43.7%）；出血性腦卒中336例（55.5%），男性220例（65.5%），女性116例（34.5%）。合并肺內(nèi)感染394例（65.1%），合并電解質(zhì)紊亂341例（53.7%）；住院天數(shù)范圍1-138小時，1-3天內(nèi)死亡的339例（56.0%）。其中，死于原發(fā)病的389例（64.3%），死于并發(fā)癥的141例（23.3%）。 3.605例急性重癥腦血管病患者中符合臨近腦死亡標準的247例（40.8%），臨近腦死亡至心肺死亡的時間范圍2-360小時，平均時間（13.14±1.570）小時，中位數(shù)9小時。247例臨近腦死亡中有202例（81.0%）先期符合臨床腦死亡的患者，臨近腦死亡至臨床腦死亡的時間范圍0-19小時，平均時間（4.11±0.253）小時，中位數(shù)3小時。 結(jié)論： 1、急性重癥腦血管病死亡患者的死亡比例與年齡相關(guān)，即年齡越大死亡比例越高；死亡患者男性比例高，且平均死亡年齡低女性；出血性腦卒中的死亡比例高于缺血性腦卒中，出血性腦卒中男性死亡年齡以中年居多，女性以年輕老年居多。 2、急性重癥腦血管病病情重，進展快3天內(nèi)病死率高；死亡原因首先是原發(fā)�。X疝），其次是并發(fā)癥。 3、急性重癥腦血管病死亡患者臨近腦死亡和臨床腦死亡出現(xiàn)率高。大部分在出現(xiàn)臨床腦死亡前3小時即出現(xiàn)臨近腦死亡；大部分在出現(xiàn)心肺死亡前9小時即出現(xiàn)臨近腦死亡。
[Abstract]:Objective: to analyze the distribution and clinical characteristics of acute severe cerebrovascular disease and to explore the time difference between brain death and cardiopulmonary death in order to reduce the death rate of acute severe cerebrovascular disease and to provide reference for understanding brain death. Methods: a total of 605 patients with acute severe cerebrovascular diseases were collected from the first affiliated Hospital of Dalian Medical University, central ICU and emergency ICU ward from January 2010 to June 2013. The general situation, survival time, clinical features and causes of death of 605 patients with acute severe cerebrovascular disease were analyzed. By summing up the consciousness, brainstem reflex and Four scores of 605 patients with acute severe cerebrovascular death, we collected the patients who met the criteria of near brain death and clinical brain death, and analyzed the adjacent brain death respectively. The time distribution of clinical brain death to cardiopulmonary death and clinical brain death. SPSS17.0 statistical software was used to analyze the data. The frequency and composition ratio of the classified variables were statistically analyzed by using the frequency and composition ratio of the classified variables, and the survival time of the event was analyzed by Kaplan-Meier method and Log Rank test method. The difference was statistically significant (P < 0.05). Results: 1.605 cases of acute severe cerebrovascular disease in men 372 cases, female 233 cases, male to female ratio 1.6: 1. The average age of male was 65.11 鹵14.885 years old, the average age of female was 71.75 鹵13.264 years old and 39 cases were under 44 years old, the ratio of male and female was 4.6: 145-59 years old 154 cases, the ratio of male and female was 3.1: 1 + 60-74 years old 169 cases, the ratio of male and female was 1.4: 1 / 75 years old or above, the ratio of male and female was 1.1: 1. There were 2.605 patients with acute severe cerebrovascular disease with ischemic stroke, 2.605 patients with acute severe cerebrovascular disease with ischemic stroke, one hundred and forty-two male patients with ischemic stroke, one hundred and forty-two male patients with acute cerebral apoplexy, and one hundred and thirty-one female patients with acute cerebral apoplexy, 55.5 patients with hemorrhagic stroke, 65.5 patients with male and 34.5 patients with female cerebral apoplexy. There were 394 cases with intrapulmonary infection and 341 cases with electrolyte disturbance. 339 cases died within 1-3 days of hospitalization in the range of 1-138 hours. Among them, 389 cases died of primary disease and 141 cases died of complications. Of the 3.605 patients with acute severe cerebrovascular disease, the time range from brain death to cardiopulmonary death was 2-360 hours, and the average time was 13. 14 鹵1. 570 hours. The median time range from brain death to clinical brain death was 0-19 hours, the average time was 4.11 鹵0.253 hours, and the median time was 3 hours. Conclusion: 1. The death rate of patients with acute severe cerebrovascular disease is related to age, that is, the higher the age, the higher the death rate; the higher the male proportion is, and the lower the average death age is, the higher the death rate of hemorrhagic stroke is compared with that of ischemic stroke. The age of death of hemorrhagic stroke was mostly middle age in male and young and old in female. 2, the acute severe cerebrovascular disease is serious, the death rate is high within 3 days, the cause of death is the primary disease (cerebral hernia), the second is the complication. 3. The incidence of near brain death and clinical brain death in patients with acute severe cerebrovascular disease is high. Most of them appeared near brain death 3 hours before clinical death and 9 hours before cardiopulmonary death.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

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