儿童缺血性卒中的临床特点及诊疗现状研究  

Clinical Characteristics and Medical Care Situation of Ischemic Stroke in Children in China

作　　者：邓亚仙[1] 张贵涛 王蕾[1] 姚春美[1] 徐娟玉[1] 刘改芬 赵成松[4] DENG Ya-Xian;ZHANG Gui-Tao;WANG Lei;YAO Chun-Mei;XU Juan-Yu;LIU Gai-Fen;ZHAO Cheng-Song(Department of Pediatrics,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;National Clinical Research Center for Neurological Diseases,Beijing 100070,China;Center of Stroke,Beijing Institute for Brain Disorders,Beijing 100070,China;Department of Outpatient,Beijing Children's Hospital,Capital Medical University,Beijing 100045,China)

机构地区：[1]首都医科大学附属北京天坛医院儿科,北京100070 [2]国家神经系统疾病临床医学研究中心 [3]北京脑重大疾病研究院 [4]首都医科大学附属北京儿童医院门诊部

出　　处：《中国卒中杂志》2021年第8期816-821,共6页Chinese Journal of Stroke

基　　金：首都医科大学科研培育基金(PYZ2019075);北京市丰台区临床重点专科项目。

摘　　要：目的分析儿童缺血性卒中的临床表现、危险因素、病因及诊疗现状。方法通过检索北京市出院病案首页,连续纳入2018年1-12月住院的缺血性卒中儿童患者,收集并分析患儿人口学信息、临床表现、卒中危险因素、实验室检查及辅助检查结果、入院后并发症、急性期治疗及出院时二级预防措施、出院时神经功能缺损情况。结果研究共纳入172例缺血性卒中患儿,男性103例(59.88%),女性69例(40.12%)。中位发病年龄为9.0(6.0~11.2)岁,7~10岁和>10岁患儿比例较高,分别为34.30%和31.40%。最常见症状为偏瘫(160例,93.02%),其次为构音障碍(43例,25.00%),全脑症状包括意识水平下降和头痛,另外,29例(16.86%)患儿有癫痫发作。159例(92.44%)患儿至少发现一种危险因素,脑血管病变为主要病因(133例,77.33%),其中最常见的为烟雾病(118例,68.60%);14例(8.14%)患儿有心脏疾病;13例(7.56%)患者未找到明确病因。急性期接受抗血小板治疗者30例(17.44%),抗凝治疗者9例(5.23%);出院时二级预防措施中仅11例(6.40%)接受抗血小板治疗,2例(1.16%)接受抗凝治疗。结论该组儿童缺血性卒中病例发病高峰是学龄期,肢体瘫痪为最常见的临床表现,烟雾病是主要病因。缺血性卒中患儿急性期及二级预防的抗血栓治疗均明显不足。Objective To investigate the clinical presentation,risk factors,causes and medical care situation of ischemic stroke in children in China.Methods The data of inpatients with ischemic stroke aged from 1 month to 18 years from hospitals in Beijing(excluding army hospital)from January 2018 to December 2018 were retrospectively analyzed.The clinical information included demographics,clinical presentation,risk factors,examination results,complications after admission,treatment in acute phase,secondary prevention and neurologic deficits at discharge.Results A total of 172 children patients were included,with a median age of 9.0 years old(range:6.0-11.2 years old)and 103 boys(59.88%).The proportion of patients aged 7-10 years old and aged over 10 years old were relatively high,34.30%and 31.40%,respectively.The most common clinical symptom was hemiplegia(n=160,93.02%),the next one was speech disturbance(n=43,25.00%),and the other symptoms included consciousness disturbance and headache.In addition,29 patients(16.86%)had seizure.159 patients(92.44%)had at least one risk factor,and cerebrovascular disease was the main cause (n =133, 77.3%), among which the most common wasMoyamoya disease (n =118, 68.60%), 14 patients (8.14%) had heart disease and no clear causeswere found in 13 patients (7.56%). 30 patients (17.44%) received antithrombotic therapy, and 9patients (5.23%) received anticoagulant therapy in the acute phase. 11 patients (6.40%) receivedantithrombotic therapy, and 2 patients (1.16%) received anticoagulant therapy for secondaryprevention at discharge.Conclusions The peak onset of ischemic stroke in children is 7-10 years old. Hemiplegia is themost common clinical presentation, and the main cause of ischemic stroke is Moyamoya disease.Antithrombotic therapy was insufficient in acute phase and secondary prevention for ischemicstroke children.

关 键 词：缺血性卒中 危险因素 儿童 治疗 

分 类 号：R743.3[医药卫生—神经病学与精神病学]