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中华神经创伤外科电子杂志 ›› 2022, Vol. 08 ›› Issue (04) : 224 -228. doi: 10.3877/cma.j.issn.2095-9141.2022.04.006

临床研究

自发性脑出血患者流行病学特点与死亡影响因素分析
汤志辉1, 黄巍1, 罗飞1, 王文浩1,()   
  1. 1. 363000 福建漳州,解放军联勤保障部队第九〇九医院(厦门大学附属东南医院)神经外科
  • 收稿日期:2022-06-21 出版日期:2022-08-15
  • 通信作者: 王文浩
  • 基金资助:
    福建省自然科学基金(2018J01152)

Analysis of epidemiological characteristics and mortality factors of patients with spontaneous intracerebral hemorrhage

Zhihui Tang1, Wei Huang1, Fei Luo1, Wenhao Wang1,()   

  1. 1. Department of Neurosurgery, the 909 Hospital of the Joint Service Support Force (Southeast Hospital Affiliated to Xiamen University), Zhangzhou 363000, China
  • Received:2022-06-21 Published:2022-08-15
  • Corresponding author: Wenhao Wang
引用本文:

汤志辉, 黄巍, 罗飞, 王文浩. 自发性脑出血患者流行病学特点与死亡影响因素分析[J/OL]. 中华神经创伤外科电子杂志, 2022, 08(04): 224-228.

Zhihui Tang, Wei Huang, Fei Luo, Wenhao Wang. Analysis of epidemiological characteristics and mortality factors of patients with spontaneous intracerebral hemorrhage[J/OL]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(04): 224-228.

目的

探讨自发性脑出血(SICH)患者的流行病学特点,并分析其死亡的影响因素。

方法

回顾性分析解放军联勤保障部队第九〇九医院神经外科自2015年1月至2021年12月收治的2765例SICH患者的流行病学资料,分析流行病学特征,并根据治疗结局将患者分为存活组(2497例)和死亡组(268例),采用单因素和Logistic多因素回归分析死亡的影响因素。

结果

2765例患者中,男女比例2.54∶1,50岁以上患者是20~50岁患者的2.48倍;第四季度发病率分别是一、二、三季度的1.85、1.88、1.61倍;凌晨发病率分别是上午、下午和晚上的1.69、1.65、1.39倍。单因素分析和Logistic多因素分析结果显示沿海地区、脑出血家族史、入院GCS评分、脑干出血、血肿体积、中线移位≥5 mm是预后的独立影响因素。

结论

本地区SICH患者中男性比例高于女性,第四季度和凌晨发病率较高,重视沿海地区和脑出血家族史人员,结合入院GCS评分、出血体积和中线移位情况可以判断患者的预后情况。

Objective

To investigate the epidemiological characteristics of patients with spontaneous intracerebral hemorrhage (SICH) and to analyze the mortality factors.

Methods

Epidemiological data of 2765 patients of SICH admitted to Neurosurgery Department of the 909th Hospital of the Joint Service Support Force from January 2015 to December 2021 were retrospectively analyzed. The epidemiological characteristics were analyzed. According to the treatment outcome, the patients were divided into survival group (n=2497) and death group (n=268). Univariate and Logistic multivariate analysis were used to analyze the influencing factors of death.

Results

Among the 2765 patients, the male to female ratio is 2.54 to 1. The number of patients aged 50 or older was 2.48 times than that of those aged 20 to 50. The incidence rate in the fourth quarter was 1.85, 1.88 and 1.61 times higher than that in the first, second and third quarters. The incidence rate of early morning was 1.69, 1.65 and 1.39 times higher than that of morning, afternoon and evening. Univariate analysis and Logistic multivariate analysis showed that coastal area, family history of intracerebral hemorrhage, admission GCS score, brainstem hemorrhage, hematoma volume, midline displacement ≥5 mm were independent prognostic factors.

Conclusion

In this region, the proportion of patients with spontaneous intracerebral hemorrhage is higher in males than in females, and the incidence rate is higher in the fourth quarter and early morning. The prognosis of the patients can be determined by paying attention to the coastal areas and family history of intracerebral hemorrhage, combined with the admission GCS score, hemorrhage volume and midline displacement.

表1 自发性脑出血患者发病性别构成[例(%)]
表2 自发性脑出血患者发病年龄构成[例(%)]
表3 自发性脑出血患者发病季节构成[例(%)]
表4 自发性脑出血患者发病时间构成[例(%)]
表5 影响自发性脑出血患者预后的单因素分析
项目 存活组(n=2497) 死亡组(n=268) χ2/t/Z P
性别[例(%)]     0.943 0.735
  1794(71.85) 189(70.52)    
  703(28.15) 79(29.48)    
年龄(岁,±s 53.41±16.75 56.84±15.38 -1.847 0.074
沿海地区[例(%)] 1233(49.37) 178(66.42) 6.864 0.011
吸烟史[例(%)] 728(29.16) 107(39.92) 0.564 0.846
脑出血家族史[例(%)] 183(7.32) 57(21.27) 17.764 <0.001
基础疾病[例(%)]        
  高血压 1957(78.37) 209(77.99) 0.357 0.826
  糖尿病 253(10.13) 31(11.57) 0.319 0.863
入院GCS评分[分,M(P25,P75)] 11(7,14) 7(4,8) 7.357 <0.001
入院生命体征[M(P25,P75)]        
  体温(℃) 36.6(36.4,37.0) 36.7(36.4,36.9) -0.454 0.637
  心率(次/min) 88(79,93) 85(80,89) 1.532 0.121
  呼吸频率(次/min) 21(16,23) 22(16,24) -0.396 0.661
  收缩压(mm/Hg) 146(135,168) 172(141,183) -2.579 0.019
实验室检查[M(P25,P75)]        
  白细胞(×109/L) 12.4(9.7,14.1) 12.7(9.9,14.7) -0.757 0.597
  血糖(mmol/L) 7.1(5.9,8.5) 9.4(7.3,12.0) -6.708 <0.001
  白蛋白(g/L) 42(38,45) 40(37,44) 1.257 0.227
  D-二聚体(mg/L) 1.1(0.4,2.8) 2.2(0.8,3.9) -7.017 <0.001
CT检查        
  脑干出血[例(%)] 16(0.64) 127(47.39) 57.427 <0.001
  血肿体积[mL,M(P25,P75)] 25(18,34) 76(48,87) -13.757 <0.001
  破入脑室[例(%)] 1 538(61.59) 217(80.97) 14.362 <0.001
  中线移位≥5 mm[例(%)] 781(31.28) 191(71.27) 20.083 <0.001
表6 自发性脑出血患者预后多因素分析
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