本文選題：青年與中老年腦出血 + 病因��； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：研究背景與目的:自發(fā)性腦出血(spontaneous intracerebral haemorrhage,sICH)發(fā)病率僅次于缺血性腦卒中,占急性期腦血管病20%-30%,是病人致殘和致死的主要原因。sICH病因及危險(xiǎn)因素眾多,好發(fā)于中老年人,臨床表現(xiàn)因出血部位而異。但近年有研究發(fā)現(xiàn)其呈現(xiàn)年輕化趨勢(shì)。青年與中老年腦出血在病因、危險(xiǎn)因素、臨床表現(xiàn)、影像學(xué)檢查及臨床結(jié)局等方面有一定差異,針對(duì)腦出血不同病因和危險(xiǎn)因素行積極預(yù)防與治療可有效減少腦出血發(fā)生和復(fù)發(fā)。腦出血影像學(xué)診斷主要是顱腦CT(Computed Tomography),其次是顱腦 MRI(Magnetic Resonance Imaging)。磁共振血管造影(magnetic resonance angiography,MRA)、CT 血管造影(Computed Tomography angiography,CTA)及數(shù)字減影腦血管造影(Digital subtraction angiography,DSA)可有助于腦出血病因的診斷,但目前腦出血后行血管造影等檢查的病人較少。近年來(lái),缺血性腦卒中病因分型及危險(xiǎn)因素等研究較多,而國(guó)內(nèi)外對(duì)出血性腦血管病病因分型及危險(xiǎn)因素等研究較少。病因分類及危險(xiǎn)因素等分析有助于評(píng)估患者、選擇有效的治療方案、判斷預(yù)后以及制定二級(jí)預(yù)防策略。臨床表現(xiàn)差異有助于腦出血早發(fā)現(xiàn)、早干預(yù)。該研究目的是通過(guò)收集與分析腦出血患者臨床資料,總結(jié)腦出血常見(jiàn)病因及危險(xiǎn)因素等方面相關(guān)特點(diǎn),比較兩者之間的差異,提高臨床醫(yī)師對(duì)該病的全面認(rèn)識(shí),為腦出血的系統(tǒng)診治提供依據(jù)。研究方法:回顧性收集我院神經(jīng)內(nèi)科2011年01月至2016年12月期間收治的腦出血病人442例。匯總所收集病例一般資料,包括性別、年齡、不良生活方式(如吸煙、飲酒、吸毒及藥物濫用情況)、既往疾病史(高血壓、糖尿病、冠心病、高脂血癥以及卒中病史)、出血部位、臨床表現(xiàn)以及出院臨床結(jié)局等相關(guān)資料;實(shí)驗(yàn)室檢測(cè)結(jié)果(血常規(guī)、血脂血糖、肝腎功能、凝血功能、病毒系列及風(fēng)濕系列指標(biāo)等);影像學(xué)檢查相關(guān)資料(顱腦CT、MRI、MRA、MRV、CTA及DSA)。因不同年齡出血病因、危險(xiǎn)因素等方面不盡相同,將所收集病人分為兩組,45歲青年組和≥45歲中老年組,應(yīng)用SPSS21行醫(yī)學(xué)統(tǒng)計(jì)學(xué)分析,比較兩組腦出血患者年齡及性別、出血部位、常見(jiàn)病因、危險(xiǎn)因素、臨床表現(xiàn)以及影像學(xué)檢查等差異。研究結(jié)果:1.發(fā)病年齡與性別差異:該研究發(fā)現(xiàn),腦出血平均發(fā)病年齡男性女性早。45歲青年腦出血例數(shù)占全部腦出血患者14.3%。所有腦出血病例男性多于女性,尤其是青年腦出血組男性明顯多于女性,差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。2.出血部位:研究發(fā)現(xiàn)基底節(jié)區(qū)是腦出血最多見(jiàn)的部位,其次是腦葉、小腦、腦干、多部位及腦室,小腦出血總體比例多于腦干出血,占全部腦出血5.4%。在兩組腦出血病例中,基底節(jié)區(qū)和腦葉出血所占比例無(wú)明顯差異,均是腦出血最常見(jiàn)的出血部位,與青年組相比,小腦出血在中老年組較常見(jiàn)。3.出血病因:根據(jù)歐洲SMASH-U分型,高血壓病是兩組腦出血最常見(jiàn)的病因,但其在青年與中老年腦出血中所占比例有一定差異,該病因在中老年組更常見(jiàn)。不明原因腦出血和血管結(jié)構(gòu)因素所致腦出血在青年腦出血中占有較大比例,而腦血管淀粉樣病變是中老年人腦出血第二大常見(jiàn)病因。4.危險(xiǎn)因素:高同型半胱胺酸血癥、血脂異常在兩組中的比列無(wú)顯著差異(P0.05)。男性、吸煙史、飲酒史及家族史等危險(xiǎn)因素在青年腦出血組更多見(jiàn),而高血壓病、糖尿病、冠心病及既往卒中病史在中老年腦出血組更常見(jiàn),差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。5.臨床表現(xiàn):肢體無(wú)力及言語(yǔ)不清比例在兩組中無(wú)顯著差別,而頭痛、嘔吐、意識(shí)障礙、肢體抽搐及小便失禁在兩組中有差別,頭痛及肢體抽搐在青年組常見(jiàn),而其他臨床表現(xiàn)在中老年組常見(jiàn)(P0.05)。6.影像學(xué)檢查與結(jié)局:所有腦出血患者僅17.6%行腦血管檢查,以顱腦MRA最多,其次是DSA檢查和CTA檢查。其中DSA檢查以青年人居多,而CTA檢查在中老年患者中多見(jiàn)。青年組住院期間死亡1例,中老年組住院期間死亡6例。結(jié)論及意義:腦出血病因及危險(xiǎn)因素眾多,臨床表現(xiàn)多樣,明確病因需更多影像學(xué)檢查及實(shí)驗(yàn)室檢測(cè),青年與中老年腦出血在很多方面都存在較明顯差異,分析兩者之間的差異有助于指導(dǎo)各自臨床治療與預(yù)防。
[Abstract]:Background and objective: the incidence of spontaneous intracerebral haemorrhage (sICH) is second only to ischemic stroke, accounting for 20%-30% in acute cerebral vascular disease. It is the main cause of disability and death of patients. The cause and risk factors of.SICH are the main cause of disability and death. There are some differences between young and middle-aged brain hemorrhage in the etiology, risk factors, clinical manifestations, imaging examination and clinical outcomes. The active prevention and treatment of cerebral hemorrhage can effectively reduce the occurrence and recurrence of cerebral hemorrhage. The imaging diagnosis of cerebral hemorrhage is mainly brain CT (Co Mputed Tomography), followed by craniocerebral MRI (Magnetic Resonance Imaging). Magnetic resonance angiography (magnetic resonance angiography, MRA), CT angiography and digital subtraction angiography can help the diagnosis of the cause of cerebral hemorrhage, but current cerebral hemorrhage In recent years, there are many studies on the etiological classification and risk factors of ischemic stroke, but there are few studies on the etiological classification and risk factors of hemorrhagic cerebrovascular disease. The analysis of the etiology and risk factors is helpful to evaluate the patients, to choose effective treatment schemes, to judge the prognosis and to determine the prognosis. The difference of clinical manifestation is helpful to the early detection of cerebral hemorrhage and early intervention. The purpose of this study is to collect and analyze the clinical data of the patients with cerebral hemorrhage, summarize the common etiological factors and risk factors of cerebral hemorrhage, compare the differences between the two, and improve the overall understanding of the disease by clinicians and for the cerebral hemorrhage. A retrospective study of 442 patients with cerebral hemorrhage admitted in our department of Neurology from 01 months to December 2016 2011. Summarize the general data, including sex, age, bad lifestyle (such as smoking, drinking, drug abuse and drug abuse), past disease history (hypertension, diabetes, coronary heart disease). A history of hyperlipidemia and stroke, bleeding site, clinical manifestation and clinical outcome of discharge, and the results of laboratory tests (blood routine, blood lipid, blood sugar, liver and kidney function, coagulation function, virus series and rheumatic Series); imaging related materials (craniocerebral CT, MRI, MRA, MRV, CTA and DSA). The risk factors were different, and the patients were divided into two groups, 45 year old youth group and more than 45 years old and elderly group. SPSS21 was used in medical statistics analysis to compare the age and sex of the two groups of cerebral hemorrhage, bleeding site, common cause, risk factors, clinical manifestation and imaging examination. The results of the study: 1. age and sex of the 1. disease. Differences: the study found that the average age of cerebral hemorrhage in male women with early.45 years of cerebral hemorrhage accounted for all cases of cerebral hemorrhage in all patients with cerebral hemorrhage more than women, especially in the young cerebral hemorrhage group more than women, the difference was statistically significant (P0.05).2. bleeding site: the study found the basal ganglia area is brain. The most common part of blood, followed by lobes, cerebellum, brainstem, multiple parts and ventricles, was more than the brain stem hemorrhage, and the proportion of 5.4%. in all two groups of cerebral hemorrhage, the proportion of basal ganglia and cerebral lobes had no significant difference, which were the most common bleeding parts of cerebral hemorrhage. Compared with the young group, the cerebellar hemorrhage was in the middle of the brain. The most common cause of.3. hemorrhage in the elderly group: according to the European SMASH-U classification, hypertension is the most common cause of cerebral hemorrhage in the two groups, but the proportion in the young and middle aged brain hemorrhage is different, the cause is more common in the middle and old age group. The cerebral hemorrhage caused by unexplained cerebral hemorrhage and vascular structure factor occupies a more important part in the young brain hemorrhage. Large proportion, and cerebrovascular amyloid disease is the second most common cause of.4. in middle-aged and elderly patients with cerebral hemorrhage: high homocysteinemia and abnormal blood lipid in the two groups, there is no significant difference (P0.05). Men, smoking history, drinking history, family history and other risk factors are more common in the young cerebral hemorrhage group, and hypertension, diabetes, coronal heart The history of disease and previous stroke was more common in the middle aged and elderly cerebral hemorrhage group, and the difference was statistically significant (P0.05).5. clinical manifestations: there was no significant difference between the two groups, but headache, vomiting, disturbance of consciousness, limb convulsion and urinary incontinence were different in the two groups, and headache and limb convulsions were common in the young group, and the other The common (P0.05).6. imaging examination and outcome in the middle and old age group: all cerebral hemorrhage patients only 17.6% lines of cerebral vascular examination, with the most brain MRA, followed by DSA examination and CTA examination. Among them, the DSA examination was mostly in young people, and the CTA examination was more common in the middle aged and elderly patients. During the period of hospitalization, 1 cases were dead, and the middle and old age group died during hospitalization. There are 6 cases of death. Conclusion and significance: there are many causes and risk factors of cerebral hemorrhage and various clinical manifestations. More imaging examination and laboratory testing are needed to clear the cause of the disease. There are obvious differences in many aspects between young and middle-aged brain hemorrhage. Analysis of the difference between the two is helpful to guide the clinical treatment and prevention.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.34

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王玲;;老年腦出血60例護(hù)理體會(huì)[J];中國(guó)民康醫(yī)學(xué);2012年04期

2 楊銘霞;;老年腦出血50例肺部感染原因分析及護(hù)理[J];中國(guó)實(shí)用神經(jīng)疾病雜志;2012年12期

3 孟海萍;老年腦出血362例護(hù)理體會(huì)[J];河北醫(yī)學(xué);1997年05期

4 黃明玉;25例老年腦出血患者的護(hù)理體會(huì)[J];廣西醫(yī)學(xué);1998年01期

5 李秀芹;老年腦出血的護(hù)理[J];牡丹江醫(yī)學(xué)院學(xué)報(bào);1998年01期

6 張國(guó)紅,郭書(shū)英,顧平,母成賢;對(duì)335例老年腦出血某些問(wèn)題的認(rèn)識(shí)[J];現(xiàn)代中西醫(yī)結(jié)合雜志;1998年11期

7 陳磊;張婧;;穿刺粉碎術(shù)在老年腦出血患者中的應(yīng)用效果[J];中國(guó)老年學(xué)雜志;2014年05期

8 陳小放;老年腦出血的臨床特點(diǎn)[J];江西醫(yī)學(xué)院學(xué)報(bào);2000年02期

9 郝素芳,馬秀清,李桂芳;老年腦出血的急救與護(hù)理[J];內(nèi)蒙古醫(yī)學(xué)雜志;2000年02期

10 鹿麗華,徐翠蘭;128例老年腦出血患者護(hù)理體會(huì)[J];泰山醫(yī)學(xué)院學(xué)報(bào);2000年03期

相關(guān)會(huì)議論文 前8條

1 謝麗珠;鐘凌英;;老年腦出血并發(fā)癥的護(hù)理[A];全國(guó)第六屆老年護(hù)理學(xué)術(shù)交流專題講座會(huì)議論文匯編[C];2003年

2 王雪麗;;護(hù)理程序在老年腦出血患者心理護(hù)理中的運(yùn)用[A];全國(guó)第五屆老年護(hù)理學(xué)術(shù)交流暨專題講座會(huì)議論文匯編[C];2002年

3 徐燕茹;;老年腦出血患者的護(hù)理[A];全國(guó)第十屆老年護(hù)理學(xué)術(shù)交流暨專題講座會(huì)議論文匯編[C];2007年

4 李敏;史麗萍;;老年腦出血合并慢性菌痢患者的康復(fù)宣教[A];中國(guó)康復(fù)醫(yī)學(xué)會(huì)第五次全國(guó)老年康復(fù)學(xué)術(shù)大會(huì)上海市康復(fù)醫(yī)學(xué)會(huì)成立20周年暨老年康復(fù)診療提高班論文匯編[C];2008年

5 季瑞芬;崔玉玲;王丹玲;;早期針灸及功能訓(xùn)練對(duì)老年腦出血術(shù)后偏癱的康復(fù)護(hù)理體會(huì)[A];全國(guó)第六屆老年護(hù)理學(xué)術(shù)交流專題講座會(huì)議論文匯編[C];2003年

6 楊曉英;張曉蔚;孫月芬;李興梧;;甘露醇治療老年腦出血致腎損害的觀察分析[A];2001年全國(guó)中西醫(yī)結(jié)合急救醫(yī)學(xué)學(xué)術(shù)會(huì)議論文集[C];2001年

7 凌云;;老年腦出血致多器官功能衰竭49例報(bào)告[A];中華醫(yī)學(xué)會(huì)第七次全國(guó)內(nèi)科學(xué)術(shù)會(huì)議論文匯編[C];1995年

8 顧迅;金怡;;老年腦出血患者應(yīng)用止血敏致劇烈嘔吐1例報(bào)告[A];第四屆全國(guó)老年醫(yī)學(xué)進(jìn)展學(xué)術(shù)會(huì)議論文集[C];2004年

相關(guān)碩士學(xué)位論文 前3條

1 張海龍;阿司匹林對(duì)中老年腦出血患者術(shù)后的影響[D];新鄉(xiāng)醫(yī)學(xué)院;2016年

2 管云飛;青年與中老年腦出血臨床特點(diǎn)分析[D];山東大學(xué);2017年

3 程媛媛;青年和中老年腦出血危險(xiǎn)因素及預(yù)后的相關(guān)研究[D];瀘州醫(yī)學(xué)院;2014年

，

本文編號(hào)：2046030