院内卒中回顾性调查研究

发布时间：2018-11-13 07:59

【摘要】：脑卒中可致死及致残，其中非卒中原因住院患者在住院期间发生的卒中被称为院内卒中[1]。脑卒中不仅造成人类的死亡，幸存的患者也常伴有不同程度的肢体活动障碍，因此脑卒中的预防及及早治疗非常重要。由于院内卒中的发生机制可能有医疗性因素及发生地点的特殊性，极易引发医患矛盾，因此对院内卒中的早期预防、诊断、治疗等是非常重要的。方法：对2012年1月-2013年1月的在吉林大学第一附属医院因非卒中原因住院，在住院期间发生脑卒中的115例患者进行回顾性调查研究。统计的临床资料主要包括性别、年龄、可能诱因、危险因素、治疗措施、出院转归等情况。从2012年1月-2013年1月以急性脑卒中为入院诊断的患者中随机抽取115例组成院外卒中对照组，，比较院内卒中及院外卒中的危险因素、住院治疗、出院转归等特点。结果：1.院内卒中共有115例，其中脑出血32例，脑梗死78例，短暂性脑缺血发作（transient ischemic attack，TIA）5例，男女之比为1：1.1，缺血性卒中患者的年龄比出血性卒中的年龄大（P0.05）。2.院内出血性卒中主要分布于肿瘤中心14例（43.8%），院内缺血性卒中主要分布于心血管内科19例（16.5%），神经外科18例（15.7%）。3.院内发病主要集中于入院后1周（68.7%）。患者被及时发现且进行有效处理的是67例（58.3%），各种原因导致的延迟被发现的有48例（41.7%）。4.25.2%的院内卒中患者是高龄者，45.2%患有高血压，25.2%患者有血脂异常，29.6%患有糖尿病，29.6%是抽烟者，15.7%是饮酒者，17.4%有房颤病史，23.5%有既往脑血管病史，且这些危险因素在缺血性卒中中更加常见，心房颤动在出血性卒中及缺血性卒中中所占的比率有较大的统计学差异（缺血性：22.9%，出血性：3.1%，P0.02）。5.缺血性卒中中手术为主要致病因素，而出血性卒中中血小板低为主要致病因素。6.院内卒中死亡率高，且出血性院内卒中比缺血性院内卒中的死亡率高，有统计学差异（P=0.001）。7.院内外卒中比较，院内卒中的房颤、心脏疾病、卒中后并发症较院外卒中常见，呼吸机使用、监护仪使用也是院内卒中比较常见，院内外卒中的患者出院时的改良的Rankin评分（Modified Rankin score，mRS）也有差别，院内卒中患者的mRS评分5和6占据43.4%，而院外卒中中仅占12.2%。结论：1、我院院内卒中以缺血性卒中为主，但出血性卒中患者的死亡率高于缺血性卒中。2、院内出血性卒中主要分布于肿瘤中心，主要诊断以白血病居多；院内缺血性卒中主要分布于心血管内科，主要诊断以冠心病居多。3、缺血性卒中患者发病因素主要为手术及心源性疾病，而出血性卒中发病因素主要为血小板减少。4、院内卒中患者与院外卒中患者比较，院内卒中患者卒中后并发症多见，出院时神经功能损害严重。5、院内卒中患者在院期间接受脑血管检查及血脂等脑血管病危险因素筛查的较少，应该加强对院内卒中发病率较高的科室医生对脑血管危险因素筛查的意识，同时应该加强对院内卒中患者的及时救治。
[Abstract]:Stroke can be fatal and maimed, of which non-stroke causes are referred to as in-hospital stroke[1] in a stroke that occurs during hospitalization. Stroke not only causes the death of human, but also the patients who have survived are often accompanied by different degrees of limb movement disorder, so the prevention and early treatment of stroke is very important. Because the occurrence mechanism of the in-hospital stroke may have the medical factors and the particularity of the place, it is very important to cause the patient-patient conflict, so the early prevention, diagnosis, treatment and the like of the in-hospital stroke are very important. Methods: In January 2012 to January, 2013, the first Affiliated Hospital of Jilin University was hospitalized for non-stroke, and 115 patients with stroke during the hospitalization were retrospectively investigated. The clinical data of statistics mainly include sex, age, possible cause, risk factors, treatment measures, discharge outcome, etc. Case: 115 patients with stroke were randomly selected from January 2012 to January 2013 in the diagnosis of acute stroke, and the risk factors, hospitalization, discharge and the like in the in-hospital stroke and out-of-hospital stroke were compared. Features. Results: 1. There were 115 cases of stroke in the hospital, including 32 cases of cerebral hemorrhage, 78 cases of cerebral infarction, transient ischemic attack (TIA) and 5 cases of transient ischemic attack (TIA). The ratio of men and women was 1: 1. The age of patients with ischemic stroke was greater than that in hemorrhagic stroke (P0. 05). 2. The hemorrhagic stroke in the hospital was mainly distributed in 14 cases (43.8%) of the center of the tumor, 19 cases (16. 5%) and 18 (15) of neurosurgery. 7%). 3. The in-hospital incidence was mainly concentrated in 1 week after admission (6 8. 7%). The patient was found in time and the effective treatment was performed in 67 (5 The delay was found in 48 (45.7%). 4. 25. 2% of the in-hospital stroke patients were the elderly, 45. 2% had high blood pressure, 25. 2% of the patients had dyslipidemia, 29. 6% had diabetes, 29. 6% were smokers, 15. 7% were drinkers, 17. 4% had a history of atrial fibrillation, and 23. 5% had a prior history. The history of cerebrovascular disease and the risk factors were more common in ischemic stroke, and the ratio of atrial fibrillation in hemorrhagic stroke and ischemic stroke was significantly different (ischemic: 22. 9%, haemorrhagic: 3.1%, P0. 02). 5. The operation in the ischemic stroke is the main pathogenic factor, and the lower platelet in the hemorrhagic stroke is the main cause Disease factor. 6. The mortality of the in-hospital stroke is high, and the rate of stroke in the hemorrhagic in-hospital stroke is higher than that of the in-hospital stroke, and there is a statistical difference (P = 0. 0 01). 7. In-hospital stroke comparison, in-hospital stroke, atrial fibrillation, heart disease, post-stroke complications are common in the external stroke of the hospital, the use of the ventilator, the use of the monitor is also common in the in-hospital stroke, the improved Rankin score (Modified Rankin score, mRS, There was also a difference in the mRS scores of 5 and 6 in the in-hospital stroke patients to be 43.4%, while in the out-of-hospital stroke only 12. 2%. Conclusion: 1. The death rate of the patients with hemorrhagic stroke is higher than that of the ischemic stroke, but the incidence of hemorrhagic stroke in the hospital is higher than that of the ischemic stroke. in that department of cardiovascular internal medicine, the main diagnosis is coronary heart disease. 3, the incidence of ischemic stroke is mainly the operation and the cardiogenic disease, and the incidence of hemorrhagic stroke is mainly thrombocytopenia. 4. the in-hospital stroke patients are compared with the patients in the outside of the hospital, and the in-hospital stroke patients After stroke, there are more complications, and the neurological function is seriously impaired at the time of discharge. 5. In-hospital stroke patients receive less screening of the risk factors of cerebrovascular diseases such as cerebral vascular examination and blood fat during the hospital, and it is important to strengthen the department doctors with higher incidence of stroke in the hospital for cerebrovascular diseases. Consciousness of risk factor screening, and should be strengthened in the hospital
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R743.3

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