脑梗死后早期神经功能恶化影响因素研究

发布时间：2018-09-12 09:49

【摘要】：研究背景与目的:进展性脑梗死(Stroke In Progression,SIP)是指急性脑梗死患者发病后在6h至1周内神经功能缺损症状逐渐进展加重[1],发病后48h-72h内发生为早期神经功能恶化(Early neurological deterioration,END),在3d-7d发生则为延迟性神经功能恶化(Delayed neurological deterioration,DND)[2]。影响END发生的相关危险因素繁多,本研究通过回顾性分析END病患的相关临床资料并讨论分析END发生的相关危险因素,为收治END病患时予以及时准确地诊疗并对预防其发生提供一定的线索和依据。方法:本研究系统性回顾性分析2014年8月-2016年10月重庆医科大学附二院神经内科收治的389例急性脑梗死患者的临床资料。根据患者出现神经功能恶化的时间将其分为END组和非END组。收集患者的一般资料(高血压病史、糖尿病病史、脑梗死病史、吸烟史、性别和年龄)、入院时临床表现(体温及NIHSS评分)、实验室指标(入院时空腹血糖及Fib、TC、TG、HDL、LDL)、影像学资料(梗死体积)。统计分析两组病例相关临床资料之间的差异,并分析讨论可能影响病患END发生的相关危险因素。结果:(1)389例急性脑梗死患者中有66例符合END的诊断标准,发生率为16.97%。(2)一般临床资料:END组与非END组在高血压病史、糖尿病病史脑梗死病史、吸烟史、性别和年龄之间的差异无统计学意义(P0.05)。(3)临床表现:END组与非END组入院时体温水平分别为36.768±0.572℃、36.526±0.641℃,其差异有统计学意义(P=0.003);两组入院时NIHSS评分分别为9.76±5.969、5.97±4.799,差异有统计学意义(P0.001)。(4)实验室检查结果:入院空腹血糖高和Fib水平高在END组与非END组之间的差异有统计学意义(P=0.008、P=0.001);而TG、TC、HDL、LDL两组之间的差异无统计学意义(P0.05)。(5)影像学检查资料:END组与非END组梗死体积分别为47.676±47.873cm3、15.502±29.299 cm3,差异有统计学意义(P0.001)。(6)多因素logistic回归分析高空腹血糖(P=0.011,OR=1.084,95%CI[1.018-1.153])、入院时NIHSS评分高(P0.001,OR=1.109,95%CI[1.049-1.171])、入院时体温水平高(P=0.011,OR=2.532,95%CI[1.233-5.200])、Fib水平高(P=0.033,OR=1.353,95%CI[1.024-1.787])、梗死体积大(P0.001,OR=1.015,95%CI[1.008-1.023])是END发生的五个独立危险因素。结论:END是急性脑梗死患者常见临床表现,本研究表明影响END发生的危险因素较多,其中入院时体温高、入院时NIHSS评分高、空腹血糖水平高、Fib水平高及梗死体积大是END发生的独立危险因素。
[Abstract]:Background & AIM: progressive cerebral infarction (Stroke In Progression,SIP) refers to the progressive exacerbation of neurological deficit symptoms in patients with acute cerebral infarction within 6 hours to 1 week after the onset of acute cerebral infarction [1]. The occurrence of 3d-7d was delayed nerve function deterioration (Delayed neurological deterioration,DND) [2]. There are many risk factors associated with the occurrence of END. This study analyzed retrospectively the clinical data of END patients and discussed the risk factors associated with the occurrence of END. To provide clues and evidences for timely and accurate diagnosis and treatment of END patients. Methods: the clinical data of 389 patients with acute cerebral infarction treated in the Department of Neurology, second Hospital of Chongqing Medical University from August 2014 to October 2016 were analyzed retrospectively. Patients were divided into END group and non-END group according to the time of neurologic deterioration. Collect general data of patients (hypertension history, diabetes history, cerebral infarction history, smoking history, Sex and age, clinical manifestations at admission (body temperature and NIHSS score), laboratory indicators (fasting blood glucose and Fib,TC,TG,HDL,LDL on admission), imaging data (infarct volume). The differences of clinical data between two groups were statistically analyzed and the risk factors related to the occurrence of END were analyzed and discussed. Results: (1) 66 out of 389 patients with acute cerebral infarction met the diagnostic criteria of END, the incidence was 16.97. (2) the general clinical data of the two groups were hypertension history, diabetes history, cerebral infarction history and smoking history. There was no significant difference between sex and age (P0.05). (3). The body temperature of the two groups was 36.768 卤0.572 鈩，

本文编号：2238638