【作者】 王瑞；

【导师】 李常新；

【作者基本信息】 山西医科大学 ， 神经病学（专业学位）， 2015， 硕士

【摘要】 目的:分析不同气象条件下脑卒中发病的时点及规律,探讨各气象要素及异常天气对脑卒中发病的影响。方法:收集山西医科大学第一医院神经内科2012年~2014年收治的太原地区急性脑卒中患者病历资料,记录该地区同期逐日气温、气压、湿度等15项基础气象资料及10项派生指标。用构成比描述脑卒中发病的月分布、季节差别和年度集中趋势;直线相关、多元线性回归分析各气象要素与脑卒中发病的关系;运用1:1配对病例对照研究探讨异常天气(寒潮、热浪)对脑卒中发病的影响。结果:1.研究纳入脑卒中患者共计2210例。脑出血419例,其中男性277例,女性142例;脑梗死1791例,其中男性1206例,女性585例。2.脑出血为冬、春季高发,其发病有两个高峰月份,分别为4月、11月;脑梗死为春季高发,高峰月份在5月。3.直线相关分析显示:脑出血发病与日最高气压、日最低气压呈正相关(r=0.114、0.107,P<0.05),与派生气象指标3日温差、日温差、7日温差呈正相关(r=0.123、0.107、0.092,P<0.05)。脑梗死与日平均气压、日平均风速呈正相关(r=0.057、0.062,P<0.05),与日最小相对湿度呈负相关(r=-0.066,P<0.05),与各派生指标无相关关系。4.多元线性回归筛选出来影响脑出血日发病人数的气象要素依次为:日最低气温、日平均气温、日温差、日平均气压、3日温差;而影响脑梗死日发病人数的依次为:日最大风速、日最低气温、日最小相对湿度、日平均气压。5.研究时段内太原地区未出现热浪天气,出现6次寒潮天气。寒潮过境影响脑出血日发病的OR值为1.807(95%CI:1.120-2.818);影响脑梗死日发病的OR值为1.090(95%CI:0.507-1.673)。提示寒潮天气的出现可造成脑出血日发病人数的增高。结论:1.脑卒中发病存在性别差异,男性明显多于女性。2.脑出血冬、春季高发,其发病有两个高峰月份,分别为4月、11月;脑梗死为春季高发,高峰月份在5月。3.不同气象要素对不同类型脑卒中发病的作用及机制存在差异,尤其脑出血易受气象波动影响。4.异常天气的出现可诱发脑出血。更多还原

【Abstract】 Objective:To analyze the time of stroke onset and its variation, explore the influence of meteorological elements on the occurrence of stroke.Methods:At the First Hospital of Shanxi Medical University, acute stroke patients who were being treated in the Department of Neurology were studied from 2012 to 2014 in Taiyuan.Simultaneously, 15 meteorological parameters were gathered, which included daily temperature, pressure, humidity etc. Besides, calculation of 10 derived indicators.Constituent ratio was implemented to describe the monthly, seasonal and yearly distribution. Linear correlation and multiple linear regressions were utilized to analyze the association between meteorological parameters and the occurrence of stroke.The influence of unusual weather(cold wave、heat wave)on the Occurrence of Stroke were analyzed by using 1∶1 one-directional retrospective design.Results:1.A total of 2,210 stroke patients were observed,among which 419 were cerebral hemorrhage(CH) cases and 1791 were cerebral infarction(CI) cases.2.High incidence of CH was found in winter and spring, the peak months were April and November, respectively. The onset of CI was higher in spring, the peak month was May.3.Linear correlation analysis showed a positive correlation between CH incidence andmaximum air pressure, minimum air pressure, temperature difference of 3 day,temperature difference of 1 day,temperature difference of 7 day((P<0.05). While the incidence of CI was positively related with average air pressure and wind speed(P<0.05), negatively with minimum humidity(P<0.05).4.Multiple stepwise regression found that the meteorological factors which influenced the incidence of CH was daily average temperature, maximum temperature, minimum air pressure,temperature difference of 3 day; the incidence of CI was affected by daily maximum wind speed, minimum air temperature, minimum humidity and daily average air pressure.5.There were six cold waves from Jan 1, 2012 to Jun 30, 2014,but we did not see the heat wave.The risk rate of CH and CI was affected by the cold wave,the values were1.807( 95% CI:1.120-2.818) and 1.090( 95% CI:0.507-1.673).Conclusions:1.There are different in the gender about the onset of stroke,More men than women significantly.2.The incidence of CH was higher in winter and spring, the peak months were April and November, respectively; the onset of CI was higher in spring, the peak month was May. 3.Different meteorological elements on the role and mechanism of different types of stroke onset, especially cerebral hemorrhage is easily affected by weather fluctuations.4.The emergence of abnormal weather can cause to happen cerebral hemorrhage.更多还原