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目的探讨脑梗死住院患者病死率及主要死亡原因。方法回顾性分析2005年1月至2009年12月515例以脑梗死为根本死亡原因的患者的临床资料,计算其住院病死率、直接死亡原因及死因构成比,分析类肝素药物Org10172治疗急性卒中试验(TOAST)分型、年龄、住院病程等临床特点。结果 (1)2005年至2009年每年脑梗死住院患者病死率依次为2.0%(91/4 659)、2.1%(110/5 264)、1.9%(95/5 035)、1.2%(100/8 656)、1.0%(119/11 640),总病死率为1.5%(515/35 254),基本呈逐年下降趋势,差异有统计学意义(χ2=42.39,P<0.01)。(2)脑梗死住院患者病死率在青年(<45岁)、中年(45~59岁)、年轻老年(60~74岁)、老年组(>74岁)分别为1.1%(22/2 009)、1.0%(112/11 158)、1.5%(221/14 311)、2.1%(160/7 776),随年龄增加而增大(P<0.01)。(3)515例死亡患者TOAST分型依次为:大动脉粥样硬化型57.3%(295例)、心源性栓塞型19.4%(100例)、不明原因型14.4%(74例)、小动脉闭塞型7.0%(36例)、其他原因1.9%(10例)。前5位直接死因:脑疝49.3%(254例)、原发性中枢性呼吸循环衰竭25.0%(129例)、肺炎8.9%(46例)、脑心综合征5.8%(30例)、多器官功能衰竭5.6%(29例)。(4)平均死亡年龄为(67±12)岁,死于脑疝和原发性中枢性呼吸循环衰竭的患者年龄明显小于死于肺炎者[分别为(65±13)、(68±11)、(75±10)岁,均P<0.01]。住院病程中位数为3.0 d,死于脑疝、原发性中枢性呼吸循环衰竭和脑心综合征的患者住院病程明显短于死于肺炎和多器官功能衰竭患者(住院病程中位数分别为3.0、3.0、3.0、12.5、9.0 d,均P<0.05)。结论脑梗死住院患者病死率呈逐年下降趋势,脑疾病本身是脑梗死患者早期死亡的最主要原因,提示临床工作中应重点防治。
Objective To investigate the mortality rate and the main causes of death in hospitalized patients with cerebral infarction. Methods The clinical data of 515 patients with cerebral infarction as the primary cause of death from January 2005 to December 2009 were retrospectively analyzed. The in-hospital mortality, direct cause of death and the cause of death were calculated. The effects of Org10172, an anti-heparin drug, on acute stroke Test (TOAST) typing, age, duration of hospitalization and other clinical features. Results (1) The mortality of inpatients with cerebral infarction was 2.0% (91/4 659), 2.1% (110/5 264), 1.9% (95/5 035), 1.2% (100 / 8 656), 1.0% (119/11 640), and the overall case fatality rate was 1.5% (515/35 254), showing a trend of declining year by year with a statistically significant difference (χ2 = 42.39, P <0.01). (2) The mortality rate of hospitalized patients with cerebral infarction was 1.1% (22/2) in young (45 years old), middle aged (45-59 years old), young (60-74 years old) and elderly (> 74 years old) (P <0.01), 1.0% (112/11 158), 1.5% (221/14 311) and 2.1% (160/7 776) with age. (3) The TOAST classification of 515 death patients were as follows: 57.3% (295 cases) with atherosclerosis, 19.4% (100 cases) with cardioembolism, 14.4% (74 cases) with unexplained causes, arteriolar occlusion Type 7.0% (36 cases), other causes 1.9% (10 cases). The top five direct causes of death were 49.3% (254 cases) of hernia, 25.0% (129 cases) of primary central respiratory failure, 8.9% (46 cases) of pneumonia and 5.8% (30 cases) of brain-heart syndrome Organ failure of 5.6% (29 cases). (4) The average age of death was (67 ± 12) years old. The patients died of cerebral hernia and primary central respiratory failure were significantly younger than those who died of pneumonia (65 ± 13 and 68 ± 11, respectively) , (75 ± 10) years old, all P <0.01]. The median duration of hospitalization was 3.0 days. The patients who died of herniation, primary central respiratory failure and brain-heart syndrome had shorter duration of hospitalization than those who died of pneumonia and multiple organ failure 3.0, 3.0, 3.0, 12.5, 9.0 d, all P <0.05). Conclusion The mortality rate of hospitalized patients with cerebral infarction is decreasing year by year. Brain disease itself is the most important cause of early death in patients with cerebral infarction, suggesting that the prevention and treatment should be focused on in clinical work.