醒后卒中的临床特征及发病时辰的探索性研究
发布时间：2018-07-23 20:00
【摘要】：醒后卒中(wake-up strokes, WUS),是指患者睡眠时发生的卒中,患者睡前无新发卒中症状,但在醒后患者本人或目击者发现其出现卒中表现。WUS因发病时间不明确,影响了早期是否静脉溶栓或血管内治疗等治疗决策,据以往的报道,这部分患者在脑卒中人群中不占少数,因此,研究醒后卒中的特征,探讨WUS能否在积极的治疗中获益,就很有意义。WUS早期的不可干预性和时间延迟性,使其成为循证医学的天然的暴露-终止效应模型,很适合探讨脑卒中早期的治疗,祖国医学认为人体具有强大的抵抗力和自愈能力,中医的治疗方法就是调节整体平衡,激发人体自身的潜能,WUSi王好又是观察疾病不受干扰的自然病程,以及人体的康复能力的自然模型。WUS与非醒后卒中(non-WU S)时间上的差异,亦可用于研究时间医学以及祖国医学的子午流注学说。目的：了解WUS的临床特征,通过“醒后”卒中与非“醒后”卒中的对比研究,探讨急性缺血性脑卒中早期治疗决策。方法：数据来源于广东省中医院脑病科大数据库,回顾性收集2012年1月1日至12月31日连续12个月内的缺血性脑梗死患者病例384例,选取72h内至我院急诊或神经科入院的急性缺血性脑卒中患者病例106例,录入基线数据、危险因素、实验室检验、影像学检查、以及与时间相关的信息,以NIHSS评分衡量神经功能缺损程度。按是否醒后才出现新发卒中症状分为WUS组和non-WUS组。用SPSS17.0软件进行统计分析,正态分布计量资料2组间用t检验,多组间用单因素方差分析；非正态分布计量资料采用秩和检验；计数资料发生率或构成比的比较采用卡方检验。对比观察WUS与non-WUS患者的临床特点,以及与发病时辰的关系,探讨子午流注学说的应用。结果：106例急性缺血性脑卒中患者中, WUS患者36例,占34.0%,non-WUS患者70例,占66.0%。WUS患者既往的危险因素明显少于non-WUS患者(P=0.005),其中两组间仅高尿酸血症所占总人数百分比有统计学差异(P0.05)；WUS患者房颤及糖尿病所占总人数百分比也较低,但差异无统计学意义(P=0.056,P=0.062),余高血压病等危险因素差异无统计学意义(P0.05)；两组性别、入院时NIHSS评分、实验室检验、检查等差异无统计学意义(P0.05)。醒后卒中与临床特征的Logistic回归分析结果提示模型差异有统计学意义(χ2=8.31,P=0.004),诊断符合率68.9%,进入方程的临床特征有患病种数,其OR=0.643,95%CI[0.467,0.886],分析提示,患病种数越多,发生醒后卒中的可能性越小,其他临床特征差异均无统计学意义(P0.05)。WUS患者3h内、4.5h内就诊人数百分比明显少于non-WUS患者(P=0.043、P=0.007)；24h内就诊的WUS患者病情较non-WUS患者轻,且越早就诊的WUS患者病情越轻,而越早就诊的non-WUS患者病情越重,但差异无统计学意义(P0.05)。WUS患者6：00～7：00(卯时)发病人数最多,0：00-2：00发现卒中的患者NIHSS评分明显低于4：00-6：00、6：00-8：00时段；non-WUS患者14：00～18：00为发病高峰；酉时NIHSS评分明显大于辰(P=0.005)、未(P=0.006)、申(P=0.005)、亥时(P=0.017)。WUS与non-WUS患者发病季节分布有统计学差异(PO.05),WUS组与non-WUS组患者2组间NIHSS评分夏季和冬季有统计学差异,WUS患者夏季临床表现较non-WUS患者更重(P=0.03),而冬季较non-WUS患者更轻(P=0.04)。结论：WUS有其独特的临床和时辰特征,西医方面提示WUS和non-WUS之间也许存在不同的发病机理及病程；中医方面提示卯时或酉时治疗的思路。
[Abstract]:After waking up stroke (wake-up strokes, WUS), it refers to the stroke in the patient's sleep. The patient has no new stroke symptoms before sleep, but after waking up, the patient or witness found that the occurrence of stroke in.WUS is not clear, which affects the early venous thrombolytic or intravascular treatment decisions. According to previous reports, this part of the patients There is no minority in the stroke population, so it is very important to study the characteristics of post wake stroke and to explore whether WUS can benefit from active treatment. It is very meaningful for the non intervention and time delay of early.WUS to make it a natural exposure termination effect model of evidence-based medicine. The body has strong resistance and self-healing ability. The treatment method of Chinese medicine is to adjust the overall balance and stimulate the potential of the human body. WUSi Wang is also a natural course to observe the undisturbed natural course of disease, and the difference between the natural model.WUS and the non wake apoplexy (non-WU S), and can also be used in the study of time medicine. Objective: to understand the clinical features of WUS and to explore the early treatment decision of acute ischemic stroke through the comparative study of "wake up" stroke and non "wake up" stroke. Methods: data from the large database of the Guangdong Province Traditional Chinese Medical Hospital encephalopathy, and a retrospective collection of 12 from January 1, 2012 to December 31st. In 384 patients with ischemic cerebral infarction within a month, 106 cases of acute ischemic stroke in the emergency or neurology department of our hospital were selected from 72h. Baseline data, risk factors, laboratory tests, imaging examinations, and time related information were used to measure the degree of neurological impairment by NIHSS score. The symptoms of new stroke were divided into group WUS and group non-WUS. Statistical analysis was carried out by SPSS17.0 software. 2 groups of normal distribution data were tested with t test, multiple groups were analyzed by single factor analysis of variance; non normal distribution measurement data were tested by rank sum test, and the ratio of counting data or composition ratio was compared with chi square test. WUS and non-WUS were compared and observed. The clinical characteristics of the patients, and the relationship with the time of the onset of the disease, the application of the meridian flow theory. Results: in 106 cases of acute ischemic stroke, 36 cases of WUS patients, 34% and 70 cases of non-WUS patients, the risk factors of 66.0%.WUS patients were significantly less than those of non-WUS patients (P=0.005), of which among the two groups, only hyperuricemia accounted for the total number of patients. There were statistical differences (P0.05), and the percentage of the total number of patients with atrial fibrillation and diabetes in WUS was also low, but there was no statistical significance (P=0.056, P=0.062), and there was no significant difference in the risk factors such as hypertension (P0.05). There was no statistical difference between the two groups of sex, NIHSS score, laboratory test, and examination (P0.05 The Logistic regression analysis of stroke and clinical characteristics suggested that the difference of the model was statistically significant (x 2=8.31, P=0.004), the diagnostic coincidence rate was 68.9%. The clinical characteristics of the equation were the number of diseases, and the OR=0.643,95%CI[0.467,0.886], the more the number of diseases, the less likely to wake up, the other clinical characteristics were poor. There was no statistically significant difference (P0.05).WUS patient 3h, the percentage of patients in 4.5H was significantly less than that of non-WUS patients (P=0.043, P=0.007), and WUS patients in 24h were lighter than non-WUS patients, and the younger the older the WUS patients were, the heavier the patient's condition was, but the difference was not statistically significant (6). The incidence of NIHSS was the most in 00 to 7:00. 0:00-2:00 found that the NIHSS score of the stroke patients was significantly lower than that of the 4:00-6:00,6:00-8:00 period; the non-WUS patient was at the peak of the onset of the onset; the NIHSS score at the eleventh hour was significantly greater than that of the Chen (P=0.005), P=0.006, P=0.005, and.WUS and non-WUS. There was a statistical difference in distribution (PO.05). The NIHSS scores between group WUS and group non-WUS were statistically different in summer and winter. The clinical manifestations of WUS patients in summer were heavier than those of non-WUS (P=0.03), but in winter were lighter than those of non-WUS patients (P=0.04). Conclusion: WUS has its unique bed and Chrono characteristics, and Western Medicine suggests that WUS and non-WUS may be between them. 瀛樺湪涓嶅悓鐨勫彂鐥呮満鐞嗗強鐥呯▼锛涗腑鍖绘柟闈㈡彁绀哄嵂鏃舵垨閰夋椂娌荤枟鐨勬，
本文编号：2140489
[Abstract]:After waking up stroke (wake-up strokes, WUS), it refers to the stroke in the patient's sleep. The patient has no new stroke symptoms before sleep, but after waking up, the patient or witness found that the occurrence of stroke in.WUS is not clear, which affects the early venous thrombolytic or intravascular treatment decisions. According to previous reports, this part of the patients There is no minority in the stroke population, so it is very important to study the characteristics of post wake stroke and to explore whether WUS can benefit from active treatment. It is very meaningful for the non intervention and time delay of early.WUS to make it a natural exposure termination effect model of evidence-based medicine. The body has strong resistance and self-healing ability. The treatment method of Chinese medicine is to adjust the overall balance and stimulate the potential of the human body. WUSi Wang is also a natural course to observe the undisturbed natural course of disease, and the difference between the natural model.WUS and the non wake apoplexy (non-WU S), and can also be used in the study of time medicine. Objective: to understand the clinical features of WUS and to explore the early treatment decision of acute ischemic stroke through the comparative study of "wake up" stroke and non "wake up" stroke. Methods: data from the large database of the Guangdong Province Traditional Chinese Medical Hospital encephalopathy, and a retrospective collection of 12 from January 1, 2012 to December 31st. In 384 patients with ischemic cerebral infarction within a month, 106 cases of acute ischemic stroke in the emergency or neurology department of our hospital were selected from 72h. Baseline data, risk factors, laboratory tests, imaging examinations, and time related information were used to measure the degree of neurological impairment by NIHSS score. The symptoms of new stroke were divided into group WUS and group non-WUS. Statistical analysis was carried out by SPSS17.0 software. 2 groups of normal distribution data were tested with t test, multiple groups were analyzed by single factor analysis of variance; non normal distribution measurement data were tested by rank sum test, and the ratio of counting data or composition ratio was compared with chi square test. WUS and non-WUS were compared and observed. The clinical characteristics of the patients, and the relationship with the time of the onset of the disease, the application of the meridian flow theory. Results: in 106 cases of acute ischemic stroke, 36 cases of WUS patients, 34% and 70 cases of non-WUS patients, the risk factors of 66.0%.WUS patients were significantly less than those of non-WUS patients (P=0.005), of which among the two groups, only hyperuricemia accounted for the total number of patients. There were statistical differences (P0.05), and the percentage of the total number of patients with atrial fibrillation and diabetes in WUS was also low, but there was no statistical significance (P=0.056, P=0.062), and there was no significant difference in the risk factors such as hypertension (P0.05). There was no statistical difference between the two groups of sex, NIHSS score, laboratory test, and examination (P0.05 The Logistic regression analysis of stroke and clinical characteristics suggested that the difference of the model was statistically significant (x 2=8.31, P=0.004), the diagnostic coincidence rate was 68.9%. The clinical characteristics of the equation were the number of diseases, and the OR=0.643,95%CI[0.467,0.886], the more the number of diseases, the less likely to wake up, the other clinical characteristics were poor. There was no statistically significant difference (P0.05).WUS patient 3h, the percentage of patients in 4.5H was significantly less than that of non-WUS patients (P=0.043, P=0.007), and WUS patients in 24h were lighter than non-WUS patients, and the younger the older the WUS patients were, the heavier the patient's condition was, but the difference was not statistically significant (6). The incidence of NIHSS was the most in 00 to 7:00. 0:00-2:00 found that the NIHSS score of the stroke patients was significantly lower than that of the 4:00-6:00,6:00-8:00 period; the non-WUS patient was at the peak of the onset of the onset; the NIHSS score at the eleventh hour was significantly greater than that of the Chen (P=0.005), P=0.006, P=0.005, and.WUS and non-WUS. There was a statistical difference in distribution (PO.05). The NIHSS scores between group WUS and group non-WUS were statistically different in summer and winter. The clinical manifestations of WUS patients in summer were heavier than those of non-WUS (P=0.03), but in winter were lighter than those of non-WUS patients (P=0.04). Conclusion: WUS has its unique bed and Chrono characteristics, and Western Medicine suggests that WUS and non-WUS may be between them. 瀛樺湪涓嶅悓鐨勫彂鐥呮満鐞嗗強鐥呯▼锛涗腑鍖绘柟闈㈡彁绀哄嵂鏃舵垨閰夋椂娌荤枟鐨勬，
本文编号：2140489
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