超高龄原发性脑出血患者临床特点和预后分析  

Analysis of clinical characteristics and outcomes in very elderly patients with primary intracerebral hemorrhage

作　　者：林森[1] 李浩[1] 董薇[2] 胡鑫[1] 谢跃兵[1] 蒋艳[1] 刘鸣[2] 游潮[1] 

机构地区：[1]四川大学华西医院神经外科,成都610041 [2]四川大学华西医院神经内科,成都610041

出　　处：《中华神经外科杂志》2013年第4期335-338,共4页Chinese Journal of Neurosurgery

基　　金：国家十二五科技支撑计划项目课题（2011BA108B05）

摘　　要：目的探讨超高龄原发性脑出血患者的临床特点和预后。方法前瞻性纳入2009年1月至2010年12月四川大学华西医院神经内外科连续性入院的原发性脑出血患者。收集人口学特征、血管危险因素、入院时血压、GCS、治疗和影像学资料。根据年龄将患者分为超高龄组（≥80岁）和非超高龄组（对照组）。随访患者脑出血后1、3、6个月的死亡和残疾。结果共纳入909例，其中超高龄组60例。超高龄组患者入院舒张压明显低于对照组（89．5mmHg vs 99．5mmHg，P〈0．001），接受手术治疗的比例明显低于对照组（13．3％vs28．6％，P=0．01）。与对照组相比，超高龄组基底节出血更少（30．0％V854．2％，P〈0．001），小脑出血更多（15．0％vs6．8％，P=0．035）。超高龄组1、3、6个月病死率和残疾率均高于对照组，但差异无统计学意义。经多因素Logistic回归分析，年龄和GCS评分是超高龄患者6个月死亡的独立影响因素（P=0．025，P=0．004）。结论超高龄原发性脑出血患者在临床特点、出血部位和治疗上与对照组存在一定差异，但这些差异并不影响其长期预后。Objective To investigate the clinical characteristics and outcomes in very elderly patients with primary intracerebral hemorrhage （PICH）. Methods Patients with PICH, who were admitted to the Department of Neurosurgery and Department of Neurology, West China Hospital, Sichuan University between January, 2009 and December, 2010, were consecutively and prospectively enrolled in this study. Data on PICH patients were collected which included demographics, risk factors, blood pressure and GCS on admission, treatment and neurological imaging results. Patients were divided into two groups： the very elderly （ 1〉80 years old） group and the control group. Patients were followed up at time points of 1 - month,3 - month and 6 - month to verify their death and disability. Results Of the 909 cases ,60 patients were in very elderly group. The very elderly patients had apparently lower diastolic pressure than patients in control group on admissi on （89. 5 mm Hg vs 99.5 mm Hg, P 〈0. 001 ）, and had lower proportion of recieving surgery treatment （ 13.3% vs 28.6%, P = 0. 01 ）. Compared to the control group, the very elderly patients had a lower frequency of basal ganglia hemorrhage （ 30. 0% vs 54. 2% , P 〈 0. 001 ） , but a higher proportion of cerebellar hemorrhage（ 15. 0% vs 6. 8% , P = 0. 035 ）. Moreover, the very elderly patients had higher rates of death and disability in 1 - month, 3 - month and 6 - month follow - up, but the difference was not statistically significant. Multivariate logistic regression determined that age and GCS score were the independent factor for the 6 - month death of very elderly patients with PICH （ P = 0. 025, P = 0. 004）. Conclusions There were some differences in clinical characteristics, intracerebral hemorrhage location and treatment between the very elderly patients and yonger people with PICH, however, these differences do not seem to influence longterm outcome.

关 键 词：原发性脑出血 超高龄 临床特点 预后 

分 类 号：R74[医药卫生—神经病学与精神病学]