多梗死性痴呆的相关因素分析

目的　回顾性分析多梗死性痴呆 (MID)的相关因素。方法　以病历资料为依据 ,按分析指标分类登记 ,尔后进行统计学处理。结果　MID组与非痴呆组性别比较无显著性差异 (P >0 0 5 ) ,MID组与非痴呆者年龄比较差异显著 (P <0 0 5 ) ,MID发生率以受教育程度≤ 6年者为高 (P <0 0 1) ,以 3次以上卒中者发生率最显著 (P <0 0 1) ,以皮质或皮质下卒中者发生率最高 (P <0 0 1) ,病灶 4个以上者发生率最高 (P <0 0 1) ,血压、血糖等 5项均异常者发生率较高 (P <0 0 1)。结论　MID发生者与性别无关 ,年龄越大MID发生率越高 ,皮质或皮质下卒中者发生率较高 ,高血压、高血脂、高粘血症、心脏病和糖尿病是MID的主要危险因素     

多发脑梗塞痴呆相关因素的临床研究

本文对68例多发梗塞性痴呆(MID)病人进行CT和临床等对比分析。结果表明,MID与脑梗塞的病因及伴随疾病相似。高血压、高血脂,高粘血症,心脏病、糖尿病仍是MID的危险因素,探讨了MID与脑梗塞部位,病灶大小及脑萎缩的关系,机理。提出了MID鉴别和防治。     

脑梗死患者6个月死亡危险因素分析:南京市第一医院卒中登记

目的探讨脑梗死的临床特征及其6个月死亡预测因素,为早期干预提供依据。方法根据南京市第一医院卒中登记,前瞻性记录2004~2008年间连续收治的脑梗死患者,详细记录患者的临床资料。于发病90 d随访患者本人或家属,记录所有临床事件及其发生时间。采用mRS量表对患者预后进行评分。使用Logistic回归模型分析各影响因素与卒中6个月死亡的关系。结果符合纳入标准脑梗死患者共计1833例,发病6个月时死亡283例,死亡率15.4%。多因素分析显示:年龄(OR=1.028,95%CI:1.014~1.043)、心房纤颤(OR=2.000,95%CI:1.272~3.145)、脑卒中(OR=1.524,95%CI:1.000~2.321)、中重度神经功能缺损(OR=5.933,95%CI:4.126~8.530)、肾功能损伤(OR=1.987,95%CI:1.150~3.435)、肺部感染(OR=3.869,95%CI:2.727~5.489)、消化道出血(OR=3.859,95%CI:1.86~8.002)是脑梗死6个月死亡的独立危险因素(均P≤0.05)。结论年龄、心房纤颤、脑卒中、中重度神经功能缺损、肾功能损伤、肺部感染、消化道出血是脑梗死6个月死亡的独立危险因素。     

颅脑损伤合并多发伤病人预后的影响因素分析

目的探讨影响颅脑损伤合并多发伤病人预后的危险因素。方法回顾性分析80例颅脑损伤合并多发伤病例资料,对造成不同预后结果的危险因素进行单因素和多因素分析。结果经治疗后,存活65例(81.25%),死亡15例(18.75%)。对造成病人死亡的危险因子进行单因素分析可见:年龄、损伤距入院治疗的时间、血糖、血小板计数、收缩压、GCS、ISS、合并损伤位置、治疗方法、治疗后并发症等都是主要影响因素。经多因素回顾分析可见,入院治疗距损伤时间(6 h)、收缩压(10.0 k Pa)、GCS评分(≤8分)、ISS评分(≥25分)、合并损伤位于胸腹部、治疗后合并休克等是造成死亡的危险因素。结论影响颅脑损伤合并多发伤病人预后的危险因素较多,针对危险因素实施针对性治疗与护理干预,对降低病人病死率具有重要意义。     

神经外科病人血流感染死亡危险因素分析

目的探讨神经外科病人发生血流感染的特点及导致病人死亡的危险因素。方法回顾性分析256例神经外科并发血流感染病人的临床资料,对导致死亡的危险因素进行单因素与多因素分析。结果 256例血流感染病人中死亡55例,病死率为21.48%。单因素分析显示:年龄(60岁)、合并心血管疾病、呼吸系统疾病、糖尿病史、伴有休克、APACHEⅡ评分(≥20分)、Pitt菌血症评分(≥6分)、手术治疗、深静脉置管、机械通气、留置导尿、使用糖皮质激素、感染菌株(复株)、多重耐药菌感染、血糖(11.1mmol/L)、血清白蛋白(30g/L)、血肌酐(1.5mg/dl)、血小板(50×10~9/L)是神经外科血流感染病人死亡的危险因素(P0.05);多因素Logistic分析结果显示:年龄(60岁)、合并心血管疾病、休克、血小板(50×10~9/L)、机械通气、留置导尿、多重耐药菌感染、血清白蛋白(30g/L)、APACHEⅡ评分(≥20分)、血糖(11.1mmol/L) 10个因素是神经外科血流感染病人死亡的独立危险因素(P0.05)。结论神经外科血流感染死亡危险因素较多,临床应针对采取干预措施。     

Alzheimer病死亡病例分析

本研究采用回顾性病例对照研究对死亡的33例住院 AD 患者进行了分析。结果表明,男性患者死亡年龄早于女性患者。存活时间>5年的患者中,女性(70%)显著高于男性(21.74%)。死亡原因主要为全身衰竭(30.3%)和肺部感染(18.2%),单因素和 Logistic 回归分析结果表明,躯体并发症、日常生活能力严重减退、阳性家族史和失语等4项为影响 AD 死亡的主要危险因素。     

不明原因性脑梗死患者预后影响因素的研究

目的探讨影响不明原因性脑梗死患者预后的因素。方法选取不明原因性脑梗死住院患者148例,采用单因素及多因素分析方法,探讨分析其预后影响因素。结果多因素回归分析显示,糖尿病、右向左分流(RLS)阳性及入院时美国国立卫生研究院卒中量表(NIHSS)评分为原因不明性脑梗死患者预后独立危险因素。结论糖尿病、RLS阳性及入院时NIHSS评分与原因不明性脑梗死患者预后不良密切相关,易造成脑梗死复发或死亡。     

儿童创伤性脑梗死恢复的影响因素以及死亡的危险因素探讨

目的探讨儿童创伤性脑梗死恢复的影响因素以及死亡的危险因素。方法对66例创伤性脑梗死患儿的临床资料进行回顾性分析。结果 66例创伤性脑梗死患儿中,死亡12例(18.2%),存活54例(81.8%),包括植物人状态6例(9.1%)。54例创伤性脑梗死存活患儿恢复时间的影响因素为大面积脑梗死、感染、复合伤(OR=2.903,OR=2.092,OR=2.859;均P0.05)。与创伤性脑梗死存活患儿比较,死亡患儿入院时GCS评分明显降低,大面积脑梗死、复合伤、低血压或休克、脑疝、癫痫的比例明显增加,脱水药物的使用尤其是大剂量使用的比例明显增加(均P0.05)。多因素Logistic回归分析发现,创伤性脑梗死患儿死亡的独立危险因素分别为入院时GCS评分降低、复合伤、低血压或休克(均P0.05)。结论影响儿童创伤性脑梗死恢复时间的因素为大面积脑梗死、感染、复合伤。入院时GCS评分低、复合伤、低血压或休克是儿童创伤性脑梗死死亡的独立危险因素。     

原发性脑干出血患者死亡危险因素分析

目的探讨原发性脑干出血患者死亡的危险因素。方法回顾性分析2016年5月至2019年5月重庆医科大学附属第三医院神经中心收治的45例原发性脑干出血患者临床资料。采用检验、独立样本t检验或非参数检验对患者的性别、年龄、血肿量、血肿分型、脑积水等相关危险因素进行组间因素特征比较,应用多因素二元logistic回归分析,明确导致原发性脑干出血患者死亡的独立危险因素。结果 45例原发性脑干出血患者,病后30 d死亡23例,病死率51.1%(23/45例)。生存组和死亡组患者在入院时对格拉斯哥昏迷评分(GCS)、血肿量、血肿直径、血肿分型、四脑室出血、脑积水和自主呼吸消失的组间因素比较,差异均有统计学意义(P0.05),是影响脑干出血患者30 d生存率的可能危险因素。二元logistic回归分析结果显示,格拉斯哥昏迷评分OR=0.667,95%CI:0.459～0.969,P=0.034)、血肿量(OR=1.515,95%CI:1.026～2.236,P=0.037)、无自主呼吸(OR=0.031,95%CI:0.001～0.718,P=0.03)为原发性脑干出血死亡的独立危险因素。结论入院时低GCS评分、血肿量大及自主呼吸消失为原发性脑干出血患者死亡的独立危险因素。     

海通对多发性脑梗死性痴呆认知功能的影响

目的观察海通对多发性脑梗死性痴呆(MID)认知功能的影响。方法92例MID患者随机分为2组:海通治疗组及对照组各46例。2组均给予常规治疗。治疗组在常规治疗基础上加用海通口服。对治疗前后2组患者简明精神状态(MMSE)评分进行评价,测定海通治疗前后血脂、血黏度。结果治疗组治疗4、6周后MMSE评分明显提高,与治疗前比较差异有统计学意义(P0.05,P0.01)。对照组治疗6周后评分比治疗前明显提高(P0.05)。治疗组治疗6周后评分显著高于对照组治疗6周后(P0.05)。实验室检查显示PGMS能明显降低MID病人的血脂、血黏度。结论海通能快速改善轻、中度MID病人的认知功能。治疗期间未见严重不良反应。     

多发梗死性痴呆的临床、CT及体感诱发电位分析

目的与方法：对４０例多发性梗死性痴呆（ＭＩＤ）患者进行临床,ＣＴ及短潜伏期体感诱发电位（ＳＬＳＥＰ）分析,结果：高血压,卒中史为ＭＩＤ的重要危险因素。ＭＩＤ临床表现为智能障碍而局灶性神经系统症状、体征则较轻微,梗死灶多位于基底节区,额叶,颞叶,且双侧梗死较单侧梗死更多见。     

Long-term survival and predictors of mortality in Alzheimer's disease and multi-infarct dementia

Long-term survival was examined for 218 patients with Alzheimer's disease (AD) and 115 patients with multi-infarct dementia (MID). The 14-year survival rate for AD was 2.4% versus an expected rate of 16.6%, and for MID 1.7% versus 13.3% expected. MID showed a more malignant natural course than AD. Men carried a less favourable survival prognosis than women, both in AD and MID: the relative risk of dying for women was half that for men in both diseases. In MID, advanced disability indicated a relative risk of dying over twice as high. In both diseases the risk of death was substantially higher in the event of occurrence of primitive reflexes.     

Survival and cause of death in Alzheimer''s disease and multi-infarct dementia

Survival and causes of death of 218 patients with Alzheimer's disease (AD) and of 115 patients with multi-infarct dementia (MID) were examined. The patients were originally found in a community-based epidemiological survey of dementia, and all patients with AD or MID alive on the prevalence day were included. The 6-years survival rate for AD was 21.1% vs. the expected rate 48.5%, that for MID 11.9% vs. 45.2% expected. A comparison of relative survival rates suggested that MID carries a less favorable survival prognosis than AD. The mean durations were: AD 5.7 years and MID 5.2 years; median duration being 5 years in both diseases. The excess mortality in both AD and MID was independent of age. In AD, the survival rate decreased with increasing severity of dementia, while in MID the mortality was the same regardless of the severity of the dementia. The dementia disorder was the underlying cause of death in 68% of AD patients, and in 38% of MID patients, bronchopneumonia being the most frequent immediate cause of death in both groups. As a cause of death, acute cerebrovascular accidents occurred more often in MID patients than in the general population of comparable age. Malignant diseases were less frequent as a cause of death in both dementia groups than in the general population.     

多发性脑梗死性痴呆相关因素和P300的研究

目的 搪塞多发性脑梗死性痴呆（ＭＩＤ）的相关因素及Ｐ３００对ＭＩＤ的诊断意义。方法对３８例ＭＩＤ和３２例无痴呆脑梗死口才的受教育程度、既往史、梗死部位进行对比分析，并用听觉Ｏｄｄ－ｂａｌｌ序列测试Ｐ３００，结果 ＭＩＤ组受教育程序低、高血压史、糖尿病史、〉２次卒中史、皮质梗死、皮质合并皮质下梗死、多发性梗死、双侧梗死者与对照组相比均有显著差异。ＭＩＤ组Ｐ３００潜伏期明显延长波幅显著降低。结论文化     

Aetiological considerations and risk factors for multi-infarct dementia.

One hundred and seventy five multi-infarct dementia (MID) patients were evaluated for risk factors for stroke as well as for the types of cerebrovascular lesions that were present. The incidence of associated risk factors for stroke were as follows: hypertension (66%), heart disease (47%), cigarette smoking (37%), diabetes mellitus (20%), moderate alcohol consumption (19%) and hyperlipidaemia (21%). The most frequently occurring type of lesions were multiple lacunar infarctions of the brain (43%). These were combined with other types of stroke in an additional 21%. Atherosclerotic occlusive disease of the carotid and vertebrobasilar arteries occurred alone in 18% and was associated with other types of stroke in another 25%. Embolic cerebral infarctions were present alone in 8% and were combined with other types of stroke in 15%. MID was more frequent in men (62%) than women (p less than 0.002). Mean bihemispheric gray matter cerebral blood flow (CBF) values showed a fluctuating course and when results were pooled and compared between different types of MID, extracranial occlusive disease and/or multiple lacunar infarctions resulted in lowest CBF values. The location of cerebral infarctions was more importantly related to cognitive impairments than was the total volume of infarcted brain. Mortality rates among 125 MID patients followed for 31 months has been 5%. Correct clinical classification of the types of cerebrovascular lesions was confirmed in three necropsied cases.     

Types of multi-infarct dementia

A series of 79 patients with multi-infarct dementia (MID) were divided into 2 groups designated cortical MID and subcortical MID, according to whether the computed tomography (CT) scan showed the presence or absence of cortical infarcts, and an absent to mild or moderate to severe degree of white matter low attenuation (WMLA). Cortical MID was characterized by repeated atherothrombotic and cardiogenic strokes, moto-sensory hemiparesis, a severer degree of aphasia, and abrupt onset of cognitive failure. Subcortical MID typically showed the following features: lacunar strokes, bulbar signs including dysarthria, pure motor hemiparesis, depression and emotional lability. WMLA was found in all patients with subcortical MID but also in over 60% of those with cortical MID. In the 2 groups CT scans showed equal frequencies of deep infarcts. When divided according to severity of WMLA, 92% of patients in the cortical MID group and 44% of those in the subcortical MID group were found to have at least one cortical infarct on the CT scan. Although cortical and subcortical MID differed in several clinical features, they did not show major differences in the risk factors for stroke, and clearly overlapped each other as regards ischaemic scores and the findings in neurological examinations and CT. Thus, it is still an open question whether cortical MID and subcortical MID, including the lacunar state and Binswanger's disease, are 2 distinct entities or merely represent the expression of biological variation while having the same etiopathogenesis.     

Is multi-infarct dementia representative of vascular dementias? A retrospective study

Multi-infarct dementia (MID) indicates a dementia disorder primarily caused by multiple cerebral infarcts. Since other pathogenetic mechanisms cause vascular dementia we evaluated clinical, CT scan and CSF neurochemical parameters of 134 MID and 67 PVD (probable vascular dementia) patients. We found no differences with regard to the presence of major risk factors. Only TIA/stroke episodes and focal neurological signs were significantly more frequent in MID than in PVD cases, an anticipable result on the basis of MID definition. CT scan findings showed a prevalence of subcortical with respect to cortical lesions in both groups, with a higher frequency in MID patients. Subjects with deep infarcts more frequently showed TIA/stroke episodes and diabetes mellitus. No differences were detectable in CSF monoamine metabolite levels. We conclude that in the majority of vascular dementias subcortical damage seems to have a major pathogenetic role.     

阿尔茨海默病患者脑脊液中Tau蛋白的含量及意义

目的：Ａｌｚｈｅｉｍｅｒ病（ＡＤ）实验室诊断指标测定。方法：ＥＬＩＳＡ测定４０例ＡＤ患者,２６例梗塞性痴呆（ＭＩＤ）患者,５８例正常人脑脊液Ｔａｕ含量。结果ＡＤ患者、ＭＩＤ患者脑脊液Ｔａｕ 蛋白含量均明显高于正常对照组（Ｐ＜０．００１）,而ＡＤ组与ＭＩＤ组差别无统计意义（Ｐ＞０．０５）。ＡＤ组Ｔａｕ蛋白含量与病程呈正相关关系（Ｐ＜０．０１,ｒ＝０．４４）,ＭＩＤ组未发现此相关关系（Ｐ＞０．ｌ）．三组测定值与年龄均无相关关系。结论：Ｔａｕ蛋白含量在 ＡＤ患者脑脊液中明显升高,在 ＭＩＤ组亦增高,故单纯测定Ｔａｕ蛋白难以鉴别ＡＤ和ＭＩＤ。作者单位：卫生部课题资助基金（批准编号：９４－１－２４６,卫生部九五攻关课题）     

Decreased cerebral blood flow precedes multi-infarct dementia, but follows senile dementia of Alzheimer type

A 7-year prospective study among 181 neurologically normal elderly volunteers (mean age, 70.6 years) revealed an incidence of 3.3%, or 0.47% new cases per year, for Alzheimer's disease (SDAT) and 5.5%, or 0.78% new cases per year, for multi-infarct dementia (MID). The unusually high incidence of MID is considered to reflect preselection of a large percentage of volunteers (48.6%) with risk factors for (but without symptoms of) atherothrombotic stroke. Of 88 volunteers at risk of stroke, 11.4% developed MID within 7 years. In MID patients, cerebral blood flow (CBF) values began to decline around 2 years before onset of symptoms, while in SDAT patients, CBF levels remained normal until symptoms of dementia appeared; thereafter, CBF declined rapidly.     

Survival in presenile Alzheimer's and multi-infarct dementias.

Duration of survival in patients who had died of presenile Alzheimer's disease (AD) or presenile multi-infarct dementia (MID) in 13 mental hospitals in Scotland are described and contrasted. The duration of survival was significantly longer from symptom onset to death in AD (mean 7.4 years) than in MID (mean 5.8 years). Most of this difference was accounted for by a longer duration between symptom onset and presentation to hospital care in AD (mean 3.2 years) than in MID (mean 2.4 years). Age at onset and gender did not influence survival duration in AD or MID.