高龄恶性大脑中动脉梗死患者的临床特点分析

Analysis on clinical characteristics of elderly patients with malignant middle cerebral artery infarction

目的探讨高龄恶性大脑中动脉梗死(mMCAI)患者的发病危险因素、临床表现和预后。方法将66例老年mMCAI患者依据年龄分为高龄组(≥80岁)36例和老年组(60~<80岁)30例。比较2组患者的临床表现、发病危险因素、出院时改良Rankin量表评分及预后。结果与老年组比较,高龄组糖尿病、吸烟和饮酒患者比率显著降低(P<0.05),心房颤动患者比率显著升高(P<0.05)。2组入院后美国国立卫生研究院卒中量表(NIHSS)评分下降程度、中线向对侧移位距离、B型钠尿肽前体、基质金属蛋白酶-9(MMP-9)和S100钙结合蛋白(S100B)水平比较,差异有统计学意义(P<0.05)。高龄组心血管事件发生率显著高于老年组(P<0.05)。高龄组死亡率27.78%,显著高于老年组的13.33%(P<0.05)。结论高龄mMCAI患者与老年mMCAI患者在发病高危因素、临床表现、并发症及预后等方面均存在显著差异,加强对高龄mMCAI患者的综合治疗尤为重要。规范高血压病、糖尿病、颈动脉狭窄等疾病的治疗,加强心房颤动患者的抗凝治疗,均有助于预防和减少脑梗死的发生。

Objective To investigate the risk factors,clinical manifestations and prognosis of elderly patients with malignant middle cerebral artery infarction(mMCAI).Methods Sixty-six elderly patients with mMCAI were divided into senile group(n=36,≥80 years old)and elderly group(n=30,60~<80 years old)according to their age.The clinical manifestations,risk factors of onset,modified Rankin Scale score at discharge and prognosis were compared between the two groups.Results Compared with the elderly group,the ratios of patients with diabetes mellitus,smoking and drinking in the senile group were significantly lower(P<0.05),and the ratio of patients with atrial fibrillation was significantly increased(P<0.05).There were significant differences in increase degree of National Institutes of Health Stroke Scale(NIHSS)scores,shift distance from midline to contralateral line,pro-B-type natriuretic peptide,matrix metalloproteinase-9(MMP-9)and S100 calcium binding protein(S100b)between the two groups after admission(P<0.05).The incidence of cardiovascular events in the senile group was significantly higher than that in the elderly group(P<0.05).The mortality rate of the senile group was 27.78%,which was significantly higher than 13.33%of the elderly group(P<0.05).Conclusion There are significant differences in the risk factors,clinical manifestations,complications and prognosis between the senile patients with mMCAI and the elderly patients with mMCAI.Therefore,it is of great importance to strengthen the comprehensive treatment for the senile patients with mMCAI.Standardized treatment of hypertension,diabetes,carotid stenosis and other diseases,and strengthened anticoagulant therapy can prevent and reduce the occurrence of cerebral infarction.