左右侧大面积MCA梗死后脑心综合征的发生率及其预后研究
发布时间：2018-09-13 14:48
【摘要】：目的1、研究左侧和右侧大面积大脑中动脉(MCA)梗死后急性期脑心综合征的发生率,探讨大脑半球不对称性与脑心综合征的关系;2、比较左侧大面积MCA梗死和右侧大面积MCA梗死患者的功能预后和生活质量,同时,比较发生脑心综合征的患者与未发生脑心综合征的患者的生活质量,进一步加强对此种特殊类型患者的认识,以期今后在临床实践中早评估、早治疗、早康复,提高临床救治水平,从而降低病残率。方法采取前瞻性队列研究,纳入2014年9月至2016年9月就诊于兰州大学第二医院的急性MCA大面积脑梗死住院患者118例。1、发病急性期患者病情评估(1)于患者入院当日收集相关临床资料,其中主要有人口学信息、既往史、个人史、主要的联系方式,并行常规心电图检查,必要时进行心电监护,发现心电图异常者,需在2-7天内复查,并密切监护患者。急诊采血送检相关指标,如心肌酶、离子及电解质(血钾、血钠),由神经专科医生对患者进行美国国立卫生院卒中量表(National Institute of Health Stroke Scale,NIHSS)的评分。(2)根据患者临床表现及CT或MRI,按梗死部位将患者分为左侧大面积MCA梗死组(LMCA梗死组)与右侧大面积MCA梗死组(RMCA梗死组),比较两组患者的基线资料及住院病死率。(3)根据脑心综合征的诊断标准,确定脑心综合征的患者,比较LMCA梗死组和RMCA梗死组患者脑心综合征的发生率。(4)根据是否发生脑心综合征,将入组患者分为脑心综合征组(CCS组)与非脑心综合征组(非CCS组),比较两组患者的基线资料,及住院病死率。2、发病1、3、6月时的随访(1)分别于患者发病1月、3月、6月对患者进行脑卒中失语患者生活质量量表(Stroke and Aphasia Quality of life scale,SAQOL-39)的评分,评价随访患者的生活质量。(2)在发病6月时对随访患者进行改良的Rankin评分(modified Rankin Scale,m RS)的评估,评价患者功能预后,(m RS评分在0-2分之间,定义为预后良好,m RS评分在3-6分之间定义为预后不良),分析影响预后的危险因素及独立危险因素。并比较LMCA梗死组与RMCA梗死组6个月的功能预后。3、统计学方法应用SPSS 19.0进行数据处理,以P0.05示差异有统计学意义。计数资料用率或构成比表示,组间比较用χ2检验或Fisher确切概率法。计量资料若符合正态分布,用均数±标准差((?)±s)表示,组间比较时,采用两独立样本t检验;不符合正态分布时采用中位数、四分位间距表示,组间比较采用非参数检验。时间因素单独效应分析用重复测量方差分析。分析半球不对称性及脑心综合征与6个月功能预后的相关性时用单变量及多变量logistic回归。以上统计均采用双侧检验。结果发病急性期总共有118例患者符合纳入标准,在发病6个月时,完成随访的患者共有94例。1、急性期变量比较(1)LMCA梗死组与RMCA梗死组两组患者的临床基本资料,包括年龄、性别、生活史(吸烟、饮酒),慢性基础病(高血压、糖尿病、高脂血症)的患病率差异均无统计学意义(P0.05)。(2)LMCA梗死组与RMCA梗死组相比,LMCA梗死组NIHSS评分高于RMCA梗死组(P0.05),两组患者CCS发生率无明显差异(72.2%vs 65.6%,P0.05),住院期间病死率无统计学差异(20.4%vs 12.5%,P0.05)。(3)CCS组与非CCS组相比较发现,两组患者的基本基线资料包括年龄、性别、生活史(吸烟、饮酒),慢性基础病史(高血压、糖尿病、高脂血症)的患病率、住院NIHSS评分、住院病死率均无统计学差异(P0.05);按梗死部位分层后,CCS组与非CCS组患者在住院时间、入院NIHSS评分、出院NIHSS评分方面均无统计学差异(P0.05)。2、发病1、3、6个月访视变量比较(1)LMCA梗死组与RMCA梗死组相比,患者SAQOL-39评分在不同时间点都有统计学差异(p0.05),CCS组与非CCS组相比,患者SAQOL-39评分在不同时间点都无统计学差异(p0.05)。(2)根据6月时m RS评分,预后良好组与预后不良组基线资料比较,包括年龄、性别、生活史(吸烟、饮酒),慢性基础病(高血压、糖尿病、高脂血症)患病率差异均无统计学意义(P0.05),入院时NIHSS评分、出院时NIHSS评分及梗死部位是预后不良的危险因素,多因素Logistic回归分析结果显示出院时NIHSS评分是6个月预后不良的独立危险因素。结论1、大面积梗死患者急性期CCS发病率68.6%,其中LMCA梗死组与RMCA梗死组CCS发病率无统计学差异(p0.05)。2、入院时NIHSS、出院时NIHSS、梗死部位均为预后不良的危险因素(p0.05),只有出院NIHSS评分是6个月预后不良的独立危险因素(P=0.000)。3、存活患者在发病1、3、6月时,SAQOL-39评分在不断增加,即生活质量随时间的延长都在改善,但LMCA梗死组患者SAQOL-39评分在不同时间点都较RMCA梗死组低,即LMCA梗死组生活质量较差。
[Abstract]:Objective 1. To study the incidence of acute cerebral-cardiac syndrome after left and right large-area middle cerebral artery (MCA) infarction, and to explore the relationship between cerebral hemispheric asymmetry and cerebral-cardiac syndrome; 2. To compare the functional prognosis and quality of life in patients with large-area left MCA infarction and large-area right MCA infarction, and to compare the incidence of cerebral-cardiac syndrome. Methods A prospective cohort study was conducted to enroll patients in Lanzhou University from September 2014 to September 2016. 118 inpatients with acute MCA massive cerebral infarction in the Second Hospital were studied. 1. The evaluation of patients'condition in the acute stage (1) Collection of clinical data on the day of admission, including demographic information, past history, personal history, main contact methods, routine electrocardiogram examination, electrocardiogram monitoring if necessary, found abnormal electrocardiogram. Emergency blood collection, such as myocardial enzymes, ions and electrolytes (blood potassium, blood sodium), was performed by neurologists on patients with the National Institute of Health Stroke Scale (NIHSS). (2) According to clinical manifestations and CT or MRI, according to infarction The patients were divided into left large area MCA infarction group (LMCA infarction group) and right large area MCA infarction group (RMCA infarction group). The baseline data and in-hospital mortality were compared between the two groups. (3) According to the diagnostic criteria of Cerebrocardiac syndrome, the patients with cerebrocardiac syndrome were determined, and the incidence of cerebrocardiac syndrome was compared between LMCA infarction group and RMCA infarction group. (4) According to the occurrence of Cerebrocardiac syndrome, the patients were divided into two groups: cerebral-cardiac syndrome group (CCS group) and non-cerebral-cardiac syndrome group (non-CCS group). The baseline data and in-hospital mortality of the two groups were compared. 2. Follow-up visits at 1, 3, and 6 months of onset were conducted in patients with aphasia after stroke in January, March and June, respectively. Stroke and Aphasia Quality of Life Scale (SAQOL-39) scores were used to evaluate the quality of life of the follow-up patients. The functional prognosis of LMCA infarction group and RMCA infarction group at 6 months was compared. 3. Statistical method SPSS 19.0 was used for data processing, and P 0.05 was used for statistical analysis. The counting data was expressed by_2 test or Fisher exact. Probabilistic method: If the measurement data conform to the normal distribution, the mean (?) + standard deviation (?) + s is used, and the two independent samples t test is used for comparison between groups; the median is used for non-normal distribution, the quartile spacing is used for comparison, and the non-parametric test is used for comparison between groups. Univariate and multivariate logistic regression were used to analyze the correlation between sex and 6-month functional prognosis in patients with acute cerebral heart syndrome. There was no significant difference between the two groups in the basic clinical data, including age, sex, life history (smoking, drinking), chronic underlying diseases (hypertension, diabetes, hyperlipidemia). (2) Compared with the RMCA infarction group, the NIHSS score of the LMCA infarction group was higher than that of the RMCA infarction group (P 0.05). The incidence of CCS in the two groups was not clear. There was significant difference (72.2% vs 65.6%, P 0.05). There was no significant difference in mortality during hospitalization (20.4% vs 12.5%, P 0.05). (3) Compared with the non-CCS group, the baseline data of the two groups included age, sex, life history (smoking, drinking), prevalence of chronic basic disease (hypertension, diabetes, hyperlipidemia), NIHSS score, hospitalization disease. There was no significant difference in the fatality rate (P 0.05). There was no significant difference in hospitalization time, NIHSS score and NIHSS score between the CCS group and the non-CCS group (P 0.05). There was no significant difference in SAQOL-39 score between CCS group and non-CCS group at different time points (p0.05). (2) According to the m RS score at 6 months, the baseline data of patients with good prognosis were compared with those of patients with poor prognosis, including age, sex, life history (smoking, drinking), prevalence of chronic underlying diseases (hypertension, diabetes, hyperlipidemia). There was no significant difference (P 0.05). The NIHSS score at admission, NIHSS score at discharge and infarction site were risk factors for poor prognosis. Multivariate logistic regression analysis showed that NIHSS score at discharge was an independent risk factor for poor prognosis at 6 months. There was no significant difference in the incidence of CCS in infarction group A (p0.05). NIHSS at admission, NIHSS at discharge, and infarction site were risk factors for poor prognosis (p0.05). Only NIHSS score at discharge was an independent risk factor for poor prognosis in 6 months (P = 0.000). SAQOL-39 score was increasing in survivors at 1, 3, and 6 months of onset, i.e, quality of life was increasing with time. But the SAQOL-39 score of LMCA infarction group was lower than that of RMCA infarction group at different time points, that is, the quality of life of LMCA infarction group was worse.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
本文编号：2241485
[Abstract]:Objective 1. To study the incidence of acute cerebral-cardiac syndrome after left and right large-area middle cerebral artery (MCA) infarction, and to explore the relationship between cerebral hemispheric asymmetry and cerebral-cardiac syndrome; 2. To compare the functional prognosis and quality of life in patients with large-area left MCA infarction and large-area right MCA infarction, and to compare the incidence of cerebral-cardiac syndrome. Methods A prospective cohort study was conducted to enroll patients in Lanzhou University from September 2014 to September 2016. 118 inpatients with acute MCA massive cerebral infarction in the Second Hospital were studied. 1. The evaluation of patients'condition in the acute stage (1) Collection of clinical data on the day of admission, including demographic information, past history, personal history, main contact methods, routine electrocardiogram examination, electrocardiogram monitoring if necessary, found abnormal electrocardiogram. Emergency blood collection, such as myocardial enzymes, ions and electrolytes (blood potassium, blood sodium), was performed by neurologists on patients with the National Institute of Health Stroke Scale (NIHSS). (2) According to clinical manifestations and CT or MRI, according to infarction The patients were divided into left large area MCA infarction group (LMCA infarction group) and right large area MCA infarction group (RMCA infarction group). The baseline data and in-hospital mortality were compared between the two groups. (3) According to the diagnostic criteria of Cerebrocardiac syndrome, the patients with cerebrocardiac syndrome were determined, and the incidence of cerebrocardiac syndrome was compared between LMCA infarction group and RMCA infarction group. (4) According to the occurrence of Cerebrocardiac syndrome, the patients were divided into two groups: cerebral-cardiac syndrome group (CCS group) and non-cerebral-cardiac syndrome group (non-CCS group). The baseline data and in-hospital mortality of the two groups were compared. 2. Follow-up visits at 1, 3, and 6 months of onset were conducted in patients with aphasia after stroke in January, March and June, respectively. Stroke and Aphasia Quality of Life Scale (SAQOL-39) scores were used to evaluate the quality of life of the follow-up patients. The functional prognosis of LMCA infarction group and RMCA infarction group at 6 months was compared. 3. Statistical method SPSS 19.0 was used for data processing, and P 0.05 was used for statistical analysis. The counting data was expressed by_2 test or Fisher exact. Probabilistic method: If the measurement data conform to the normal distribution, the mean (?) + standard deviation (?) + s is used, and the two independent samples t test is used for comparison between groups; the median is used for non-normal distribution, the quartile spacing is used for comparison, and the non-parametric test is used for comparison between groups. Univariate and multivariate logistic regression were used to analyze the correlation between sex and 6-month functional prognosis in patients with acute cerebral heart syndrome. There was no significant difference between the two groups in the basic clinical data, including age, sex, life history (smoking, drinking), chronic underlying diseases (hypertension, diabetes, hyperlipidemia). (2) Compared with the RMCA infarction group, the NIHSS score of the LMCA infarction group was higher than that of the RMCA infarction group (P 0.05). The incidence of CCS in the two groups was not clear. There was significant difference (72.2% vs 65.6%, P 0.05). There was no significant difference in mortality during hospitalization (20.4% vs 12.5%, P 0.05). (3) Compared with the non-CCS group, the baseline data of the two groups included age, sex, life history (smoking, drinking), prevalence of chronic basic disease (hypertension, diabetes, hyperlipidemia), NIHSS score, hospitalization disease. There was no significant difference in the fatality rate (P 0.05). There was no significant difference in hospitalization time, NIHSS score and NIHSS score between the CCS group and the non-CCS group (P 0.05). There was no significant difference in SAQOL-39 score between CCS group and non-CCS group at different time points (p0.05). (2) According to the m RS score at 6 months, the baseline data of patients with good prognosis were compared with those of patients with poor prognosis, including age, sex, life history (smoking, drinking), prevalence of chronic underlying diseases (hypertension, diabetes, hyperlipidemia). There was no significant difference (P 0.05). The NIHSS score at admission, NIHSS score at discharge and infarction site were risk factors for poor prognosis. Multivariate logistic regression analysis showed that NIHSS score at discharge was an independent risk factor for poor prognosis at 6 months. There was no significant difference in the incidence of CCS in infarction group A (p0.05). NIHSS at admission, NIHSS at discharge, and infarction site were risk factors for poor prognosis (p0.05). Only NIHSS score at discharge was an independent risk factor for poor prognosis in 6 months (P = 0.000). SAQOL-39 score was increasing in survivors at 1, 3, and 6 months of onset, i.e, quality of life was increasing with time. But the SAQOL-39 score of LMCA infarction group was lower than that of RMCA infarction group at different time points, that is, the quality of life of LMCA infarction group was worse.
【学位授予单位】：兰州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3
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