老年脑损伤住院患者流行病学调查及对策分析

目的 调查华山医院神经外科急救中心暨国家老年病中心老年脑损伤住院患者诊治现状及流行病学特征,并为预防和救治老年脑损伤提供参考.方法 对华山医院神经外科急救中心自2005年1月1日至2015年12月31日收治的年龄≥65岁的老年住院患者进行流行病学调查研究,使用SPSS 20进行统计描述、x2检验及Logistic回归分析.结果 1 243例老年脑损伤患者中男女之比为2.42:1,年龄(73.21±6.52)岁,老年患者数量逐年增加.老年患者中急性脑损伤、慢性硬膜下血肿(chronic subdural hematoma,CSDH)、高血压脑出血分别占40.55％、34.75％、9.57％,其中CSDH数量及手术量增长明显.老年人脑损伤主要原因为摔伤(38.94％),而其受伤地点以家中最多(44.65％),其次是公共场所.有基础疾病老年患者数量逐年上升,75.19％的恶化病例和80.39％的死亡病例是由脑损伤相关因素(脑疝等)造成的.患者的入院格拉斯哥意识评分(gasgow coma score,GCS)、年龄、糖尿病史、院内感染以及疾病诊断与预后相关.结论 神经损伤相关疾病的老年患者逐年增多,特别是CSDH.根据老年人受伤情况,应提升家庭及公共场所的安全防护,针对预后相关因素进行重点治疗.

Analysis of epidemiological investigation on the brain injury of elderly inpatients and strategy of medical care to deal with from 2005 to 2015

Objective To investigate epidemiological features and clinical current status of brain injury in aged inpatients admitted in Neurosurgical Emergency Center & National Geriatrics Center of Huashan Hospital in order to provide evidence and guidelines for prophylaxis and treatment of craniocerebral trauma.Methods The data of 1 243 elderly inpatients with brain injury admitted from 2005 to 2015 were analyzed.Chi-square test and Logistic regression analysis by using SPSS 20 software.Results Of them,29.24％ were female.Totally,there were 40.55％ patients suffered from acute brain injury,34.75％ patients with CSDH (Chronic Subdural Hematoma) and 9.57％ patients with HCH (hypertensive cerebral hemorrhage).The number of operation of CSDH significantly increased year by year.The primary cause of brain injury in the elderly was tumble injury (38.94％) happened mostly at home,and then followed by public places.The number of aged inpatients with underlying diseases escalated from 2005 to 2015.Brain injury (including cerebral hernia,etc.) made 75.19％ aged patients deteriorated and 80.39％ elderly casualties died.Prognosis was associated with GCS (Glasgow consciousness scale) scores at admission,age,precise diagnosis,diabetes,nosocomial infection and coagulation function.Conclusions The number of aged inpatients suffering from brain injury,especially CSDH,increased in recent years.According to the results of medical care,measures should be taken to improve familial and public safety facilities for senior citizens.Treatment should be focused on factors associated with outcomes.