老年保健人群颅内出血病因变化及预后危险因素分析

Changes in etiology and risks factors for prognosis in elderly patients with intracranial hemorrhage

目的 回顾性研究保健人群颅内出血的病因变化及影响预后的危险因素。方法 纳入解放军总医院第二医学中心全部临床科室收治的老年颅内出血患者303例,根据年代队列分为队列1组(1983~2000年)88例,队列2组(2001~2010年)97例,队列3组(2011~2018年)118例。比较3组病因学、临床特点及其危险因素等。结果 与队列1组比较,队列2组和队列3组年龄、外伤性脑出血、淀粉样脑血管病、脑叶和硬膜下出血比例显著升高,高血压脑出血及基底核区出血比例明显降低,队列3组1个月内病死率明显降低,队列2组脑室出血比例明显升高(P<0.05,P<0.01)。多部位出血、抗凝联合抗血小板增加1个月内死亡风险(95%CI:1.095~16.647,95%CI:1.669~217.967,P<0.05)。年龄、多部位出血是1年内死亡的危险因素(95%CI:1.014~1.103,95%CI:1.516~14.533,P<0.01)。结论 保健人群颅内出血的病因谱发生变化,需加强老年人抗栓药物使用安全。

Objective To retrospectively investigate the etiology and risk factors of prognosis in elderly patients with intracranial hemorrhage.Methods A total of 303 consecutive elderly patients with intracranial hemorrhage admitted to Second Medical Center of Chinese PLA General Hospital were enrolled in this study.The patients were divided into 3 chronological cohorts: 88 cases from Cohort 1(1983-2000),97 cases from Cohort 2(2001-2010) and 118 cases from Cohort 3(2011-2018).Etiology, clinical characteristics and risk factors were compared in the cohorts.Results Compared with Cohort 1,the age, the proportions of traumatic, amyloid angiopathic, lobar and subdural hemorrhage were significantly increased, the proportions of hypertensive intracerebral and basal ganglia hemorrhage were significantly decreased in Cohort 2 and 3,1-month case fatality rate was significantly decreased in Cohort 3,and the intraventricular hemorrhage was significantly increased in Cohort 2(P<0.05,P<0.01).Bleeding from multiple sites and anticoagulant combined with antiplatelet therapy were risk factors of 1-month case fatality(95%CI:1.095-16.647,95%CI:1.669-217.967,P<0.05).Age and bleeding from multiple sites were risk factors of 1-year case fatality(95%CI:1.014-1.103,95%CI:1.516-14.533,P<0.01).ConclusionThe constituent ratio of etiology has changed in elderly patients with intracranial hemorrhage, and the safety of antithrombotic drugs should be further evaluated in them.