儿童动脉缺血性与出血性脑卒中的危险因素及转归

The comparison and analysis of risk factors and outcomes of arterial ischemic stroke and hemorrhagic stroke in children

目的总结儿童动脉缺血性卒中（AIS）和出血性卒中（HS）的临床特点、危险因素及转归。方法回顾性分析和比较2010年11月至2014年5月诊治的142例AIS和HS患儿的临床资料。结果 AIS 92例（64.8%）,男60例、女32例,发病年龄（4.6±3.6）岁（1个月~16岁）;HS 50例（35.2%）,男34例、女16例,发病年龄（2.6±3.7）岁（1个月-13岁）;两组患儿的年龄差异有统计学意义（P=0.007）。AIS最常表现为局灶神经功能受损,其中肢体瘫痪73例（79.3%）、中枢性面瘫30例（32.6%）、语言障碍19例（20.7%）;HS最常表现为弥散神经功能受损,其中意识障碍29例（58.0%）、恶心/呕吐22例（44.0%）、头痛14例（28.0%）。AIS常见危险因素为脑动脉病49例（53.3%）、感染47例（51.1%）、头部轻微外伤史16例（17.4%）;HS常见危险因素为维生素K缺乏22例（44.0%）、脑血管畸形8例（16.0%）、血液系统疾病6例（12.0%）。AIS患儿死亡5例（6.4%）,致残48例（61.5%）,复发9例（11.5%）;HS患儿死亡15例（34.1%）,致残19例（43.2%）;HS病死率高于AIS,差异有统计学意义（P〈0.01）。结论儿童脑卒中HS所占比例并不低,且预后较AIS更差。

Objectives To study the clinical characteristics,the risk factors and outcomes of arterial ischemic stroke（AIS） and hemorrhagic stroke（HS） in children.Methods The clinical data from 142 children with AIS or HS were retrospectively reviewed and compared from Nov.2010 to May 2014.Results In these children,92 cases（64.8%） was diagnosed of AIS,amont whom there were 60 males and 32 females and the onset age of stroke was 4.6±3.6 years（1 months to 16 years old）,and 50 cases（35.2%） was diagnosed of HS,among whom there were 34 males and 16 females and the onset age of stroke was 2.6±3.7 years（1 months to 13 years old）.The difference in age between two groups was statistically significant（P=0.007）.The most commonpresentation of AIS were focal neurological dysfunction including paralysis（73 cases,79.3%）,central facial palsy（30 cases,32.6%） and speech impairment（19 cases,20.7%）.The most common presentation of HS were diffuse neurological dysfunction including dizziness（29 cases,58.0%）,nausea/vomiting（22 cases,44.0%） and headache（14 cases,28.0%）.The major risk factors of AIS were arteriopathy（49 cases,53.3%）,infection（47 cases,51.1%） and minor head injury（16 cases,17.4%）.The major risk factors of HS were vitamin K deficiency（22 cases,44.0%）,intracranial vascular anomalies（8 cases,16.0%） and haematological disorders（6 cases,12.0%）.Five cases（6.4%） were died,48 cases（61.5%） became disabled and 9 cases（11.5%） were relapsed in children with AIS while 15 cases（34.1%） were died,19 cases（43.2%） became disabled in children with HS.The mortality was significantly higher in children with HS than that in children with AIS（P〈0.01）.Conclusions In childhood stroke,HS occurs more frequently than is commonly appreciated and it has a poorer prognosis than AIS.