四川省人民醫(yī)院10年住院神經(jīng)外科疾病構(gòu)成特點(diǎn)及預(yù)后分析
發(fā)布時(shí)間：2018-09-17 18:43
【摘要】：目的:基于四川省人民醫(yī)院神經(jīng)外科10年住院數(shù)據(jù),分析近十年住院神經(jīng)外科疾病的流行病學(xué)特點(diǎn)、疾病預(yù)后及演變情況。以期為深入研究神經(jīng)外科疾病提供參考。方法:利用四川省人民醫(yī)院住院病歷系統(tǒng),收集四川省人民醫(yī)院神經(jīng)外科2007年1月1日至2016年12月31日10年間共收治23,562例住院病人的資料及相關(guān)數(shù)據(jù),統(tǒng)計(jì)分析神經(jīng)外科住院各類疾病的患病情況(疾病構(gòu)成比)、人群分布(性別、年齡),手術(shù)及并發(fā)癥、合并癥、病死率和出院預(yù)后,及這些特征隨時(shí)間的變化情況。結(jié)果:(1)疾病構(gòu)成及演變:顱腦損傷、腦血管病、顱腦腫瘤仍為神經(jīng)外科的三大主要疾病,10年內(nèi)總的構(gòu)成順序及2014年前每年其構(gòu)成位序分別是顱腦損傷、腦血管病、顱腦腫瘤;2014年開始每年的構(gòu)成位序逐漸發(fā)生了變化,2014年腦血管病(27.47%)超過顱腦損傷(26.60%)成為神經(jīng)外科第一大疾病,2015年顱腦腫瘤(23.86%)逐漸成為第二大主要疾病,顱腦外傷構(gòu)成比僅為23.72%,此后神經(jīng)外科三大疾病構(gòu)成位序?yàn)槟X血管疾病、顱腦腫瘤、顱腦外傷。(2)住院病死率:總病死率為5.94%,各病種的病死率逐年下降,以顱腦損傷和腦血管疾病最為明顯,顱腦損傷病死率由2007年的11.93%降至2016年的3.61%,腦血管疾病病死率由2007年的15.87%降至2016年的4.72%。(3)疾病的性別構(gòu)成:男性住院人數(shù)高于女性(1.43:1);顱腦損傷多發(fā)生在男性(2.94:1);顱內(nèi)動(dòng)脈瘤好發(fā)于40歲以上女性(0.55:1);顱內(nèi)常見的惡性腫瘤如膠質(zhì)母細(xì)胞瘤(1.51:1)、腦轉(zhuǎn)移瘤(1.49:1)好發(fā)于男性;顱內(nèi)常見的良性腫瘤如腦膜瘤(0.46:1),神經(jīng)鞘瘤(0.55:1),垂體瘤(0.88:1)則好發(fā)于女性;三叉神經(jīng)痛(0.57:1)及面肌痙攣(0.53:1)均好發(fā)于女性。(4)疾病的年齡分布:顱腦損傷主要在青年及中老年,中年比率最高(38.41%),慢性硬膜下血腫好發(fā)于60歲以上人群(74.24%),腦血管疾病集中在中老年組(83.47%),顱腦腫瘤主要集中在中青年(79.54%),79.38%的GBM發(fā)生于40歲以上人群,三叉神經(jīng)痛(97.18%)及面肌痙攣(86.53%)均好發(fā)于40歲人群。(5)疾病的發(fā)病形式:88.04%自發(fā)性SAH源于顱內(nèi)動(dòng)脈瘤,67.25%顱內(nèi)動(dòng)脈瘤患者表現(xiàn)為出血,4.29%顱內(nèi)動(dòng)脈瘤患者伴隨動(dòng)眼神經(jīng)麻痹;46.88%的腦動(dòng)靜脈畸形患者因出血而就診。(6)�？剖中g(shù)及術(shù)后顱內(nèi)感染:除顱腦損傷外其它各大病種年�？剖中g(shù)量不斷增長(zhǎng),但術(shù)后顱內(nèi)感染發(fā)生率也逐漸上升。(7)合并癥及影響預(yù)后因素:高血壓為神經(jīng)外科疾病中最普遍的合并癥。年齡升高(OR=0.86,95%CI:0.84-0.91)、高血壓(OR=0.91,95%CI:0.83-0.99)、肺部感染(OR=0.72,95%CI:0.64-0.80),合并癥數(shù)量(除高血壓、肺部感染外的)(OR=0.89,95%CI:0.87-0.19)是患者死亡和疾病好轉(zhuǎn)或治愈率下降的危險(xiǎn)因素。結(jié)論:近10年四川省人民醫(yī)院神經(jīng)外科住院收治病人資料提示:(1)腦血管疾病、顱腦腫瘤已經(jīng)超越顱腦損傷分別成為威脅人群健康的第一大與第二大神經(jīng)外科疾病,而顱腦損傷逐漸成為第三大神經(jīng)外科疾病。(2)住院病人中的男性多于女性,41-65歲病人比例最高,不同病種病人的年齡性別分布有差異(3)各類疾病的病死率呈現(xiàn)逐年下降趨勢(shì),好轉(zhuǎn)率或有效率呈逐年上升的趨勢(shì),但腦血管疾病依然為神經(jīng)外科致死率最高、好轉(zhuǎn)率最低的疾病,需要進(jìn)一步加強(qiáng)對(duì)腦血管疾病治療的研究。(4)應(yīng)采取綜合措施來預(yù)防患者術(shù)后顱內(nèi)感染等并發(fā)癥的發(fā)生,降低病死病殘率。(5)男性、年齡升高、合并高血壓、肺部感染、合并癥數(shù)量增多(除高血壓、肺部感染外的)均為影響治療效果的危險(xiǎn)因素。
[Abstract]:OBJECTIVE: To analyze the epidemiological characteristics, prognosis and evolution of neurosurgical diseases in Sichuan People's Hospital in the past ten years, based on the data of neurosurgery in Sichuan Province People's Hospital for 10 years. Data and related data of 23,562 hospitalized patients from January 1, 2007 to December 31, 2016 were analyzed. The prevalence of various diseases (disease composition ratio), population distribution (sex, age), operation and complications, complications, mortality and discharge prognosis, and the changes of these characteristics with time were analyzed. (1) Disease composition and evolution: craniocerebral injury, cerebrovascular disease, and craniocerebral tumors are still the three major diseases in neurosurgery. The overall composition sequence in 10 years and the annual composition sequence before 2014 are craniocerebral injury, cerebrovascular disease, and Craniocerebral Tumor respectively. The composition sequence of each year has gradually changed since 2014, and cerebrovascular disease (27.47%) in 2014 has exceeded that in 2014. Transcranial brain injury (26.60%) became the first major disease in neurosurgery, and craniocerebral tumors (23.86%) gradually became the second major disease in 2015. The proportion of craniocerebral trauma was only 23.72%. Since then, the three major diseases in neurosurgery were cerebrovascular diseases, craniocerebral tumors and craniocerebral trauma. (2) In-hospital mortality: the total mortality rate was 5.94%, and the mortality of various diseases was only 23.72%. The mortality of craniocerebral injury decreased from 11.93% in 2007 to 3.61% in 2016, and the mortality of cerebrovascular disease decreased from 15.87% in 2007 to 4.72% in 2016. Aneurysms are predominant in women over 40 years old (0.55:1); common intracranial malignancies such as glioblastoma (1.51:1), brain metastases (1.49:1) are predominant in men; benign intracranial tumors such as meningioma (0.46:1), neurilemmoma (0.55:1), pituitary adenoma (0.88:1) are predominant in women; trigeminal neuralgia (0.57:1) and facial spasm (0.53:1) are predominant. (4) Age distribution of the disease: craniocerebral injury mainly occurred in young people and middle-aged and old people, the highest rate of middle-aged (38.41%), chronic subdural hematoma predominantly occurred in people over 60 years old (74.24%), cerebrovascular diseases concentrated in the middle-aged and old group (83.47%), craniocerebral tumors mainly concentrated in young and middle-aged (79.54%), 79.38% of GBM occurred in people over 40 years old, trigeminal nerve. Pain (97.18%) and hemifacial spasm (86.53%) were predisposed to 40-year-old people. (5) Pathogenesis of the disease: 88.04% of spontaneous SAH originated from intracranial aneurysms, 67.25% of patients with intracranial aneurysms showed bleeding, 4.29% of patients with intracranial aneurysms accompanied by oculomotor nerve paralysis, 46.88% of patients with cerebral arteriovenous malformations were treated for bleeding. (6) Specialized surgery and postoperative intracranial aneurysms. Infection: Except for craniocerebral injury, the number of specialized operations increased year by year, but the incidence of intracranial infection increased gradually after operation. (7) Complications and prognostic factors: hypertension was the most common complication in neurosurgical diseases. Age increased (OR = 0.86, 95% CI: 0.84-0.91), hypertension (OR = 0.91, 95% CI: 0.83-0.99), pulmonary infection (OR = 0.83-0.99). 72,95% CI: 0.64-0.80), the number of complications (except hypertension and pulmonary infection) (OR = 0.89,95% CI: 0.87-0.19) were the risk factors of death, improvement of disease or decrease of cure rate. (2) Males were more than females, and the proportion of patients aged 41-65 was the highest. The age and sex distribution of patients with different diseases were different. (3) The mortality of various diseases showed a downward trend year by year, and the improvement rate was higher. However, cerebrovascular diseases are still the diseases with the highest fatality rate and the lowest improvement rate in neurosurgery. It is necessary to further strengthen the research on the treatment of cerebrovascular diseases. (4) Comprehensive measures should be taken to prevent the occurrence of postoperative intracranial infection and other complications, and to reduce the mortality and disability rate. (5) Male, age increased, combined. Hypertension, pulmonary infection, and increased number of complications (except hypertension and pulmonary infection) are all risk factors affecting the outcome of treatment.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651
本文編號(hào)：2246783
[Abstract]:OBJECTIVE: To analyze the epidemiological characteristics, prognosis and evolution of neurosurgical diseases in Sichuan People's Hospital in the past ten years, based on the data of neurosurgery in Sichuan Province People's Hospital for 10 years. Data and related data of 23,562 hospitalized patients from January 1, 2007 to December 31, 2016 were analyzed. The prevalence of various diseases (disease composition ratio), population distribution (sex, age), operation and complications, complications, mortality and discharge prognosis, and the changes of these characteristics with time were analyzed. (1) Disease composition and evolution: craniocerebral injury, cerebrovascular disease, and craniocerebral tumors are still the three major diseases in neurosurgery. The overall composition sequence in 10 years and the annual composition sequence before 2014 are craniocerebral injury, cerebrovascular disease, and Craniocerebral Tumor respectively. The composition sequence of each year has gradually changed since 2014, and cerebrovascular disease (27.47%) in 2014 has exceeded that in 2014. Transcranial brain injury (26.60%) became the first major disease in neurosurgery, and craniocerebral tumors (23.86%) gradually became the second major disease in 2015. The proportion of craniocerebral trauma was only 23.72%. Since then, the three major diseases in neurosurgery were cerebrovascular diseases, craniocerebral tumors and craniocerebral trauma. (2) In-hospital mortality: the total mortality rate was 5.94%, and the mortality of various diseases was only 23.72%. The mortality of craniocerebral injury decreased from 11.93% in 2007 to 3.61% in 2016, and the mortality of cerebrovascular disease decreased from 15.87% in 2007 to 4.72% in 2016. Aneurysms are predominant in women over 40 years old (0.55:1); common intracranial malignancies such as glioblastoma (1.51:1), brain metastases (1.49:1) are predominant in men; benign intracranial tumors such as meningioma (0.46:1), neurilemmoma (0.55:1), pituitary adenoma (0.88:1) are predominant in women; trigeminal neuralgia (0.57:1) and facial spasm (0.53:1) are predominant. (4) Age distribution of the disease: craniocerebral injury mainly occurred in young people and middle-aged and old people, the highest rate of middle-aged (38.41%), chronic subdural hematoma predominantly occurred in people over 60 years old (74.24%), cerebrovascular diseases concentrated in the middle-aged and old group (83.47%), craniocerebral tumors mainly concentrated in young and middle-aged (79.54%), 79.38% of GBM occurred in people over 40 years old, trigeminal nerve. Pain (97.18%) and hemifacial spasm (86.53%) were predisposed to 40-year-old people. (5) Pathogenesis of the disease: 88.04% of spontaneous SAH originated from intracranial aneurysms, 67.25% of patients with intracranial aneurysms showed bleeding, 4.29% of patients with intracranial aneurysms accompanied by oculomotor nerve paralysis, 46.88% of patients with cerebral arteriovenous malformations were treated for bleeding. (6) Specialized surgery and postoperative intracranial aneurysms. Infection: Except for craniocerebral injury, the number of specialized operations increased year by year, but the incidence of intracranial infection increased gradually after operation. (7) Complications and prognostic factors: hypertension was the most common complication in neurosurgical diseases. Age increased (OR = 0.86, 95% CI: 0.84-0.91), hypertension (OR = 0.91, 95% CI: 0.83-0.99), pulmonary infection (OR = 0.83-0.99). 72,95% CI: 0.64-0.80), the number of complications (except hypertension and pulmonary infection) (OR = 0.89,95% CI: 0.87-0.19) were the risk factors of death, improvement of disease or decrease of cure rate. (2) Males were more than females, and the proportion of patients aged 41-65 was the highest. The age and sex distribution of patients with different diseases were different. (3) The mortality of various diseases showed a downward trend year by year, and the improvement rate was higher. However, cerebrovascular diseases are still the diseases with the highest fatality rate and the lowest improvement rate in neurosurgery. It is necessary to further strengthen the research on the treatment of cerebrovascular diseases. (4) Comprehensive measures should be taken to prevent the occurrence of postoperative intracranial infection and other complications, and to reduce the mortality and disability rate. (5) Male, age increased, combined. Hypertension, pulmonary infection, and increased number of complications (except hypertension and pulmonary infection) are all risk factors affecting the outcome of treatment.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R651
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