不同年龄组自发性蛛网膜下腔出血的临床特点分析

Analysis of the clinical features for spontaneous subarachnoid hemorrhage in different age groups

目的:分析不同年龄组自发性蛛网膜下腔出血患者的临床特点。方法:对不同年龄组自发性蛛网膜下腔出血患者的发病诱因、临床表现、并发症及预后进行对比研究。结果:老年自发性蛛网膜下腔出血患者发病诱因多为情绪剧烈变化、排便、咳嗽(34.9%),起病隐匿、诱因不明显发病者次之(25.6%),中、青年患者以剧烈活动或大量饮酒后发病多见(P<0.01);临床症状不典型,头痛、呕吐、意识障碍程度轻或缺如,其发生率分别为60.5%、30.2%、55.8%,与中青年患者比较,差异有统计学意义(P<0.01);并发症常见,脑血管痉挛、肺部感染、心脏病变、肾功能损害和上消化道出血的发生率分别为27.9%、41.9%、58.1%、44.2%、18.6%,与中青年患者比较,差异有统计学意义(P<0.01、P<0.05)。结论:老年人自发性蛛网膜下腔出血临床症状不典型,对起病急骤、血压显著增高、伴有意识障碍时,即使没有头痛或脑膜刺激征不明显,也应考虑到本病的可能。同时应注意老年人自发性蛛网膜下腔出血并发症的防治,提高患者的生存率。

Objective： To analyze the different age groups spontaneously clinical characteristics of patients with subarach- noid hemorrhage. Methods： Spontaneous subarachnoid hemorrhage in different age groups of patients with predisposing factors, clinical manifestations, complications and prognosis were compared. Results： For elderly patients with spontaneous subarachnoid hemorrhage, the predisposing factors were the dramatic changes in mood, defecation, cough （34.9%）, next factors for morbidity concealmtent or the morbidity cause is not obvious （25.6%）, in young patients it sees more common with severe activity or after the onset of heavy drinking （P〈0.01）; typical clinical symptoms, headache, vomiting, disturbance of consciousness was mild or absent, the rates were 60.5%, 30.2%, 55.8%, with the middle-aged patients very significant difference （P〈0.01）; complications common, the incidence of heart attack, cerebral vasospasm, pulmonary infection, renal impairment, upper gastrointestinal bleeding were 27.9%, 41.9%, 58.1%, 44.2%,18.6%, with young patients very significant difference （P〈0.01, P〈0.05）. Conclusion： The elderly SAH clinical symptoms typical of rapid onset, blood pressure increased significantly, accompanied by unconsciousness, even without the headache or meningeal irritation is not obvious, we should also take into account the possibility of this disease, and pay more attention to the prevention of complications of aged SAH, so we can improve the survival rate.