醒后卒中的病因与早期临床预后研究

发布时间：2018-04-09 00:02

本文选题：醒后卒中　切入点：缺血性卒中　出处：《安徽医科大学》2015年硕士论文

【摘要】：目的探讨醒后卒中的病因与醒后卒中对于患者早期临床转归的影响。从而为指导二级预防及对醒后卒中的预后评价提供客观依据。方法连续收集安徽医科大学附属合肥医院神经内科2012年6月至2014年6月入院的急性缺血性卒中患者,根据患者的发病时间不同,分为醒后卒中组与非醒后卒中组。比较两组间人口统计学、影像学资料,分析醒后卒中病因。分别对入院患者行美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)运动评分和出院患者进行改良Rankin量表(modified Rankin Scale,mRS)评分, 根据出院时患者mRS评分不同,将患者分为预后不良组(mRS≥2分)与预后良好组(0≤mRS≥1分),对两组患者早期预后评价。结果本研究对象急性缺血性卒中患者526例,排除发病后入院时间7天；卒中发生时间和环境信息缺失的患者；缺乏相关卒中严重程度记录和出血性卒中患者106例,最终纳入420例。其中,男266例,女154例,平均年龄(69±12)岁,醒后卒中组有103例,其余317例为非醒后卒中组。1.病因学：单因素分析显示,醒后卒中组大动脉粥样硬化型卒中构成比(23.3%对34.7%,P=0.031)、空腹血糖(6.1±2.1对6.6±3.7,P=0.012)显著低于非醒后卒中组；甘油三酯(2.0±2.1对1.8±1.0,P0.001)、小血管闭塞型卒中(21.4%对11.0%,P=0.008)、房颤病史(25.2%对11.8%,P=0.015)患者的构成比显著高于非醒后卒中组。多变量logistic回归分析显示,房颤病史、空腹血糖、甘油三酯水平及脑卒中的分型均不是醒后卒中发病的预测因素。2.预后：单因素分析显示,预后不良组醒后卒中构成比(31.2%对18.9%,P=0.003)、房颤病史(24.0%对11.8%,P=0.001)以及入院时NIHSS评分(11.8±3.8对5.0±2.8,PO.001)患者构成比显著高于预后良好组,预后不良组中发病至入院时间显著低于预后良好组(20.9±22.9对16.6±17.4,P=0.004)。多变量logist ic回归分析结果显示入院时NIHSS评分(OR 2.007,95%CI：1.749～2.304；P0.001)是卒中预后不良的独立预测因素。结论从研究中我们发现：醒后卒中患者与非醒后卒中患者病因无明显差异。而醒后卒中与早期功能转归不佳是有联系,醒后卒中患者初始的NIHSS显著高于非醒后卒中患者的评分,且醒后卒中与非醒后卒中的mRS分布显著不同。
[Abstract]:Objective To study the causes of post - resuscitation stroke and the effect of post - resuscitation stroke on early clinical outcome of patients with acute ischemic stroke .
Patients with missing stroke and missing environmental information ;
Among them , there were 106 males , 154 females , average age ( 69 卤 12 ) years , 103 in post - wake stroke group , and 317 non - post - wake stroke group . 1 . etiology : single factor analysis showed that the ratio of post - resuscitation stroke group to large atherosclerotic stroke ( 23.3 % vs . 34.7 % , P = 0.031 ) , fasting blood glucose ( 6.1 卤 2.1 vs 6.6 卤 3.7 , P = 0.012 ) was significantly lower than that in non - wake stroke group ;
The ratio of triglyceride ( 2.0 卤 2.1 to 1.8 卤 1.0 , P0.001 ) , small vessel occlusion stroke ( 21.4 % vs 11.0 % , P = 0.008 ) , the history of atrial fibrillation ( 25 . 2 % vs 11.8 % , P = 0.015 ) were significantly higher than those in non - wake stroke . The results of logistic regression analysis showed NIHSS score ( OR 2.007 , 95 % CI : 1.749 ~ 2.304 ) at admission .
P0.001 ) is an independent predictor of poor prognosis in stroke . Conclusions From the study we have found that there is no significant difference in the etiology of post - resuscitation stroke patients with non - wake - up stroke . The initial NIHSS in post - wake stroke is significantly higher than that of non - post - wake stroke patients , and the mRS distribution in post - wake stroke and non - wake stroke is significantly different .

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R743.3

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