中青年与老年人群脑叶出血特点分析(附620例报告)

Clinical features of lobar hemorrhage in younger and aged patients

目的探讨脑叶出血患者的临床特点,并分析中青年与老年人群脑叶出血的病因、临床表现及预后。方法收集解放军总医院神经内科连续收治的620例自发性脑出血患者,记录以下指标:性别,年龄,危险因素,病因,发病早期伴随症状,Glasgow昏迷量表评分和神经功能缺损评分,出血部位和出血量,住院期间并发症和治疗结果。将患者分为脑叶出血组(n=73)与非脑叶出血组(n=547),比较两组各指标的差异。在脑叶出血患者中,以60岁为界分为中青年(<60岁)组(n=27)和老年(≥60岁)组(n=46),比较两组各指标的差异。结果脑叶出血组与非脑叶出血组患者的性别构成无统计学差异。脑叶出血在各年龄段脑出血患者中所占比例呈U形分布,30岁以下及90岁以上比例最高,60至69岁比例最低。出血部位以顶叶最多见。与非脑叶出血组比较,脑叶出血组有高血压病史者较少,癫痫发生率较高,两组病损程度和治疗结果无统计学差异。在脑叶出血患者中,中青年组和老年组的病因均以高血压为最多,但中青年组的病因种类较多,脑淀粉样血管病引起的脑叶出血只见于老年组。中青年组癫痫发作(18.5%)和意识状态完全正常(GCS=15分)的患者比例(55.6%)高于老年组(分别为2.2%和28.3%,P<0.05),但两组的神经功能缺损评分、出血量、继发脑室出血以及并发症发生情况无统计学差异。中青年组治愈率(48.1%)高于老年组(23.9%,P<0.05),但两组死亡率(分别为25.9%和23.9%)相似。结论脑叶出血与其他部位出血比较有其特异性,中青年与老年人群脑叶出血在病因、病理方面有较大差异。

Objective To analyze the clinical features of lobar hemorrhage and the differences in etiology,clinical manifestation and prognosis between young,middle-aged and aged patients.MethodsSix hundred and twenty patients with spontaneous intracranial hemorrhage （ICH） were consecutively admitted to our hospital.The following data were recorded：gender,age,risk factors,cause of disease,symptoms at the early stage,Glasgow coma score （GCS） and Neurological deficit scale （NDS）,bleeding part and amount,complications during hospital stay and outcome.Patients were divided into lobar hemorrhage group （n=73） and non-lobar hemorrhage group （n=547）,and compared with each other on the parameters mentioned above.Patients with lobar hemorrhage were subdivided into young and middle-aged subgroup （60 years,n=27） and aged subgroup （≥60 years,n=46）,and compared with each other on the parameters mentioned above.ResultsThere was no difference in gender between lobar and non-lobar hemorrhage groups.The percentage of lobar hemorrhage in patients with ICH varied as a U-type in different age groups,being highest in those younger than 30 years and those elder than 90 years,and lowest in those aged between 60 and 69 years.The bleeding part mostly located at the parietal lobe in lobar hemorrhage group.Compared with non-lobar hemorrhage group,patients with lobar hemorrhage had less hypertension history and higher incidence of seizure,but there were no significant differences in neurological deficit and outcome between the two groups.Hypertension was the most common cause in all the patients with lobar hemorrhage,but a wider range of causes was seen in the young and middle-aged subgroup,while cerebral amyloid angiopathy （CAA） was only seen in the aged subgroup.The ratios of patients with seizure （18.5%） and with normal conscious state （GCS=15,55.6%） were higher in the young and middle-aged subgroups than in the aged subgroup （2.2% and 28.3%,respectively,P0.05）.There were no significant differences in NDS,bleeding amount,secondary ventricle hemorrhage and complications between the two subgroups.The cure rate was higher in the young and middle-aged subgroups than in the aged subgroup （48.1% vs 23.9%,P0.05）,but the mortality was similar between the two subgroups （25.9% vs 23.9%）.ConclusionsLobar hemorrhage shows specificity itself in comparison with non-lobar hemorrhage.The etiology and pathology of lobar hemorrhage are different for younger and aged patients.