本文選題：腦出血 + 危險因素��； 參考：《山東大學》2014年碩士論文

【摘要】：腦出血是嚴重危害人類健康的一種多發(fā)病和常見病。除軀體功能障礙外,包括記憶在內的認知方面的病殘是影響腦出血后生存質量的重要因素,因此腦出血的預防和治療一直是神經科學界關注的焦點。然而,不同部位腦出血的危險因素和認知損害特點目前尚不明了,這影響了腦出血的有效防治。為此,本研究旨在探討不同部位腦出血危險因素的異同和腦出血恢復期記憶成分受損特點。 第一部分不同部位腦出血危險因素的臨床研究 目的探討不同部位腦出血危險因素的異同。 研究對象和方法選取2012-2014年在神經內科門診就診及住院的腦出血患者97例,其中基底節(jié)出血36例,丘腦出血36例,腦葉出血25例及同期健康體檢者100例。調查收集人口學資料、疾病史、生活習慣及血清甘油三酯(TG),總膽固醇(TC),高密度脂蛋白膽固醇(HDL-C),低密度脂蛋白膽固醇(LDL-C)指標。 結果 1.腦出血危險因素分析 1.1分類變量單因素分析吸煙、飲酒、高血壓為出血性腦卒中的危險因素,與對照組比較差異有統(tǒng)計學意義(P0.05)。性別、糖尿病、冠心病腦出血組與對照組相比,差異無統(tǒng)計學意義(P0.05)。 1.2連續(xù)變量單因素分析SBP、DBP為出血性腦卒中的危險因素,與對照組比較差異有統(tǒng)計學意義(P0.05)。HDL、TC為腦出血的保護性因素(P0.05)。年齡、LDL、TG腦出血組與對照組相比,差異無統(tǒng)計學意義(P0.05)。 1.3多因素logistic回歸分析飲酒、高血壓、LDL是出血性腦卒中的獨立危險因素1, P0.05), TC為腦出血的保護性因素(OR=0.25,P=0.000)。 2.不同部位腦出血危險因素分析 2.1分類變量單因素分析吸煙、飲酒、高血壓為基底節(jié)與丘腦出血的危險因素,與對照組比較差異有統(tǒng)計學意義(P0.05)。吸煙、飲酒是腦葉出血的危險因素,性別、糖尿病、冠心病在對照組與腦出血亞型組,差異均無統(tǒng)計學意義(P0.05)。 2.2連續(xù)變量單因素分析年齡、SBP、DBP為基底節(jié)出血性腦卒中的危險因素,SBP、DBP為丘腦出血與腦葉出血性腦卒中的危險因素,與對照組比較差異有統(tǒng)計學意義(P0.05)。HDL是基底節(jié)出血與丘腦出血的保護性因素(P0.05),TC是基底節(jié)出血與腦葉出血的保護性因素(P0.05)。TG在對照組與腦出血亞型組,差異均無統(tǒng)計學意義(P0.05)。 2.3不同部位腦出血危險因素的多因素分析高血壓、LDL是基底節(jié)腦出血的危險因素,TC是基底節(jié)腦出血的保護性因素。飲酒、高血壓是丘腦出血的危險因素。飲酒是腦葉出血的危險因素,TC是腦葉出血的保護性因素。 結論飲酒、高血壓是腦出血的獨立危險因素,TC是腦出血的保護性因素。不同部位的腦出血其危險因素不同。高血壓是基底節(jié)、丘腦深部腦出血的危險因素,飲酒是丘腦、腦葉出血的危險因素。 第二部分不同部位腦出血恢復期記憶障礙的臨床研究 目的探討不同部位的腦出血記憶損害特點,為及早識別和干預腦出血后的記憶損害,延緩血管性癡呆(VD)的發(fā)生提供依據。 研究對象和方法選擇25例基底節(jié)腦出血、10例丘腦出血患者和50名健康查體者,應用韋氏記憶量表(WMS)、韋氏成人智力量表(WAIS-RC)詞匯分測驗和Rey聽覺詞語學習測驗工具,進行不同記憶成分的檢測。分別比較基底節(jié)腦出血、丘腦出血患者與正常對照組,基底節(jié)腦出血與丘腦出血以及左右基底節(jié)腦出血之間的測量結果。3個組別的性別、年齡、受教育程度比較差異無統(tǒng)計學意義。 結果基底節(jié)腦出血在短時記憶(1-100、100-1、累加、圖片回憶、視覺再認、視覺再生、聯想學習、觸覺記憶)、工作記憶(倒背)、語義記憶(詞匯測試)、延遲回憶(短延遲回憶、長延遲回憶)等記憶指標上與正常對照組的差異有統(tǒng)計學意義(P0.05)。丘腦出血在長時記憶(定向)、短時記憶(1-100、100-1、累加、圖片回憶、視覺再認、視覺再生、聯想學習、觸覺記憶)、工作記憶(倒背)、語義記憶(詞匯測試)、延遲回憶(短延遲回憶、長延遲回憶)等記憶指標上與正常對照組的差異有統(tǒng)計學意義(P0.05)。左側基底節(jié)腦出血聯想學習明顯低于右側基底節(jié)腦出血(P0.05),視覺再認右側基底節(jié)腦出血明顯低于左側,差異具有顯著性(P0.01),而語義記憶左右兩側基底節(jié)腦出血差異無統(tǒng)計學意義(P0.05)。 結論腦出血恢復期仍存在記憶功能障礙,不同部位的腦出血記憶成分受損不同。
[Abstract]:Cerebral hemorrhage is a kind of multi - morbidity and common diseases which seriously harm human health . In addition to somatic dysfunction , cognitive impairment including memory is an important factor affecting the quality of life after intracerebral hemorrhage . Therefore , the prevention and treatment of cerebral hemorrhage has been the focus of neuroscientific community . However , the risk factors and cognitive impairment characteristics of cerebral hemorrhage in different parts are still unknown , which affects the effective prevention and treatment of cerebral hemorrhage .

Clinical study on risk factors of intracerebral hemorrhage in different parts of the first part

Objective To explore the similarities and differences of risk factors of intracerebral hemorrhage in different parts .

Methods The subjects and methods were selected for 97 cases of cerebral hemorrhage patients who visited and were hospitalized from 2012 to 2014 , including 36 cases of basal ganglia hemorrhage , 36 cases of thalamus hemorrhage , 25 cases of cerebral lobe hemorrhage and 100 cases of healthy physical examination in the same period . The data of population , history of diseases , living habits and serum triglyceride ( TG ) , total cholesterol ( TC ) , high density lipoprotein cholesterol ( HDL - C ) and low density lipoprotein cholesterol ( LDL - C ) were collected .

Results

1 . Analysis of risk factors of cerebral hemorrhage

1 . The risk factors of smoking , alcohol consumption and hypertension were analyzed by the single factor of categorical variables . There was no significant difference compared with the control group ( P0.05 ) . There was no significant difference in sex , diabetes and coronary heart disease cerebral hemorrhage group compared with the control group ( P0.05 ) .

1.2 The risk factors of SBP and DBP for hemorrhagic stroke were analyzed by single factor of continuous variables ( P0.05 ) . HDL and TC were protective factors of cerebral hemorrhage ( P0.05 ) .

1.3 Multivariate logistic regression analysis showed that alcohol intake , hypertension and LDL were independent risk factors of hemorrhagic stroke ( 1 , P0.05 ) , TC was protective factor of cerebral hemorrhage ( OR = 0.25 , P = 0.000 ) .

2 . Analysis of risk factors of cerebral hemorrhage in different parts

2.1 The risk factors of smoking , alcohol consumption and hypertension were the risk factors of basal ganglia and thalamus hemorrhage compared with the control group ( P0.05 ) . There was no significant difference between the control group and the cerebral hemorrhage subtype group ( P0.05 ) .

2 . The risk factors , SBP and DBP were the risk factors of hemorrhagic stroke in basal ganglia , SBP and DBP were the risk factors of hemorrhagic stroke in basal ganglia ( P0.05 ) . HDL was the protective factor of basal ganglia hemorrhage and cerebral hemorrhage ( P0.05 ) .

2.3 Multi - factor analysis of risk factors of cerebral hemorrhage in different parts is a risk factor for cerebral hemorrhage in basal ganglia . TC is a protective factor for cerebral hemorrhage in basal ganglia . Drinking is a risk factor for cerebral hemorrhage . Drinking is a risk factor for cerebral hemorrhage . TC is a protective factor for cerebral hemorrhage .

Conclusion Alcohol consumption and hypertension are independent risk factors of cerebral hemorrhage , TC is the protective factor of cerebral hemorrhage . The risk factors of cerebral hemorrhage in different parts are different . Hypertension is a risk factor for basal ganglia and deep cerebral hemorrhage in thalamus . Drinking is a risk factor for thalamus and cerebral hemorrhage .

A clinical study on the memory impairment of different parts of cerebral hemorrhage in different parts of the second part

Objective To explore the characteristics of cerebral hemorrhage memory impairment at different sites , and to provide a basis for early identification and intervention of memory impairment after cerebral hemorrhage and to delay the occurrence of vascular dementia ( VD ) .

Twenty - five cases of basal ganglia hemorrhage , 10 cases of thalamus hemorrhage and 50 healthy controls were selected by the study object and method . The results were compared between the cerebral hemorrhage in basal ganglia , the Wechsler Adult Intelligence Scale ( WAIS - RC ) vocabulary test and the Rey auditory word learning test tool . The results were compared between the basal ganglia hemorrhage and the thalamus hemorrhage and the cerebral hemorrhage in the left and right basal ganglia .

Results The memory indexes of basal ganglia hemorrhage were significantly lower than those in the normal control group ( P0.05 ) . The cerebral hemorrhage in the left basal ganglia was significantly lower than that in the normal control group ( P0.05 ) . The cerebral hemorrhage in the left basal ganglia was significantly lower than that in the right basal ganglia ( P0.05 ) .

Conclusion There is still memory dysfunction in the recovery period of cerebral hemorrhage , and the memory impairment of cerebral hemorrhage in different parts is different .
【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.34

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本文編號：2110545