80岁以上高龄患者急性脑梗塞的临床特点分析

目的:探讨超过80岁的高龄急性脑梗塞患者的临床特点。方法:58例高龄(均≥80岁)急性脑梗塞患者,大多数行头颅MRI平扫加弥散加权成像(DWl),少数行CT检查。依影像学结果按梗塞病灶的大小分为两组:大面积梗塞(直径>1.5cm)及小面积梗塞(直径≤1.5cm,主要为腔隙性梗塞)组。回顾比较两组间发病特点;糖尿病、高血压、颈动脉硬化、冠心病、房颤的发生率;治疗方法、平均住院时间、30天病死率、日常生活活动能力(ADL)等临床指标。结果:大面积梗塞组占16例(27.6%),小面积梗塞组占42例(72.4%)。首发症状中大面积梗塞组以意识障碍(87.5%vs23.8%;P=0.018)、严重偏瘫(93.8%vs28.6%;P=0.012)、头痛(43.8%vs14.3%;P=0.026)、言语障碍等症状为主,小面积梗塞以以肢体无力、行走不稳(64.3%vs6.3%;P=0.001)、头昏、眩晕(52.4%vs25.0%;P=0.028)、言语不清、感觉障碍等症状为主。大面积梗塞组房颤高发(43,8%vs14.3%;P=0.030),小面积梗塞组高血压(88.1%vs56.3%;P=0.041)、糖尿病(54.8%vs18.8%;P=0.021)高发。在大面积梗塞组急性期用低分子肝素抗凝较多(75.0%vs40,5%;P=0.035),两组均以口服抗血小板药物为主。大面积梗塞组的并发症较多,平均住院日为小面积梗塞组的近二倍,死亡率较后者明显增高(25.0%vs4.8%;P=0.035)。结论:高龄急性脑梗塞患者以较小面积的腔隙性脑梗塞多见。小面积梗塞组高血压、糖尿病的发生较高。大面积梗塞组房颤的发生较高,有较高的死亡率,预后较差,需要更积极的综合诊治管理。常规尽早行头颅MRI加DWI有助于急性脑梗塞的早期诊断治疗。

Characteristic of acute ischemic infarction in the very elderly

Objective:To investigate the clinical features,neuroimaging data,and outcome of acute ischemic infarction events occurring in individuals aged 80 years or olden Methods:MRI、 DWI or CT,were performed among 58 elderly acute ischemic infarction patients admitted to our unit over a 2-year period.Patient age varied from 80 to 94 years(mean = 83.4 years),and 89% were males.Acodding to the focus of infarction,the patients separated into two groups.Patients in Group I had large infarcts on MR1 and extensive neurological deficits,while patients in Group 11 had small lacunar infarcts and minor neurological findings.The charts of all the patients were reviewed retrospectively and data on hypertension,diabetes mellitus,carotid stenosis,atrial fibrillation,hypercholesterolemia,coronary artery disease,treatments and outcome.Results:The results showed that the first clinic'al 'symptomatology in Group 1 were disorders of consciouseness(87.5% versus 23.8%;P=0.018),headache(43.8% versus 14.3%;P=0.026)and serious hemiplegia(93.8% versus 28.6%;P=0.012)to see frequently.In Group II hemiparesis(64.3% versus 6.3%;P=0.001)and vertigo(52.4% versus 25.0%;P=0.028)were more common.Patients in Group I showed a significantly lower proportion of diabetes(18.8% versus 54.8%;P=0.021)and hypertension(56.3% versus 88.1%;P=0.041)and a higher proportion of atrial fibrillation(43.8% versus 14.3%;P=0.030).Prevalence of carotid stenosis,hypercholesterolemia,coronary artery disease seems similar to that in Group II.Anticoagulants therapy(75.0% versus40.5%;P=0.035)was usually used in Group I.Antiplatelet agents were regularity used in both groups.The 30-day case fatality rate was approximately quintuple as high as in Group II patients(25.0% versus4.8%;P=0.001),and disability(activity of daily living,ADL score)in survivors was markedly higher(37.2±5.6 versus 19.2±3.6;p=0.021).Conclusions:The results indicate that major infarction are less prevalent in the geriatric population than small lacunar infarction and tend to be more related to hypertension and diabetes.The poorer infarction outcome found in major infarction during the first month MRI and DW1 patterns in acute stage should be helpful to verify etiology ofischemic infarction.Early synthetic management should be adopted during the very elderly with acute ischemic infarction.