超高龄原发性脑出血患者的临床特点及预后

Clinical characteristics and outcomes of primary intracerebral hemorrhage in the very elderly patients

目的探究超高龄（≥80岁）原发性脑出血患者的临床特点和预后情况。方法回顾性分析本院2011年1月至2013年1月期间收治170例原发性脑出血患者临床资料（超高龄者45例，对照组125例），对比超高龄患者（≥80岁）和对照组（〈80岁）在临床症状、体征、影像学表现、疾病治疗等的差异，比较分析两组患者的生存情况。结果超高龄组中，女性所占的比例高于对照组，既往有高血压病史者、起病时有明确诱因或处于活动状态、入院时收缩压、舒张压低于对照组（P〈0．05）。超高龄组脑叶出血的情况多于对照组（31．1％比12．0％，P〈0．05），基底节出血的情况则少于对照组（37．8％比62．4％，P〈0．05）；超高龄组采用手术治疗低于对照组，在住院时间上长于对照组，中位累积生存时间低于对照组（P〈0．05）。结论超高龄原发性脑出血可能是一种特殊类别的脑出血，脑血管淀粉样变性极有可能是其发病的重要病因。

Objective To investigate the clinical characteristics and outcomes of primary intracerebral hemorrhage （PICH） in very elderly patients aged over 80 years. Methods The clininl data of 170 patients who were diagnosed with PICH in our hospital between January 2011 and January 2013 were retrospectively analyzed. These patients comprised 45 very elderly subjects （≥80 years old） and 125 controls aged below 80. The differences in the clinical symptoms, signs, radiographic manifestations and treatments between the very elderly patients and the controls were compared. The survival in the both groups was also analyzed. Results Compared with controls, the very elderly group showed a higher proportion of female gender, and were less likely to have a past history of hypertension, obvious predisposing factors or activities prior to onset, and had lower systolic and diastolic blood pressures at admission. Cerebellar hemorrhage was more common （31.1% vs 12.0%, P〈0.05）, while the basal ganglia hemorrhage was less frequent （37.8%vs 62.4%, P〈0.05）, in the very elderly group than in the control group. Compared with the controls, lower rate of surgery treatment, longer hospital stay and shorter median survival time were found for the very elderly group （P〈0.05）. Conclusion PICH in the very elderly patients appears to be a unique category of cerebral hemorrhage, which may be significantly associated with cerebrovascular amyloidosis.