缺血性脑卒中患者疲劳发生率及其影响因素研究

发布时间：2019-05-29 01:55

【摘要】：目的本研究旨在调查首发缺血性脑卒中患者发病后2周、1个月、3个月、6个月的疲劳发生率,了解其变化趋势,并分析不同时间点卒中后疲劳的影响因素,为下一步根据不同时间点的影响因素制定有针对性的干预措施、缓解患者疲劳提供理论依据。方法本研究为调查性研究。根据研究对象的纳入和排除标准,便利选取2015年10月~2016年5月在郑州大学第一附属医院神经内科住院治疗的440例缺血性脑卒中患者作为研究对象。患者入院后2周内完成基线调查。调查内容包括社会人口学资料、卒中后疲劳发生情况及其临床相关因素(疾病严重程度、血生化指标、疼痛、卒中后抑郁、睡眠质量、应对方式等)。采用疲劳严重度量表评估患者的卒中后疲劳状况。通过主观资料、量表评估和客观资料了解患者卒中后疲劳的影响因素。卒中后1个月、3个月、6个月分别进行随访调查,内容包括卒中后疲劳、MRS评分、疼痛、卒中后抑郁、睡眠质量及应对方式得分情况。应用SPSS17.0统计软件包进行资料的统计分析,采用均数±标准差、频数、百分比进行数据的统计描述;采用χ2检验、Kruskal-Wallis非参数检验、两独立样本t检验进行疲劳的单因素分析;采用logistic回归分析进行疲劳影响因素的多因素分析,P0.05有统计学意义。结果1本研究共纳入首发缺血性脑卒中患者440例,平均年龄为62.43±12.09岁,其中男性占59.5%,已婚占91.1%。患者入院时轻微脑缺血者(NIHSS评分≤3分)占62.9%,无明显残障者(MRS2分)占33.9%,平均入院血糖为(6.08±1.51)mmol/L。经过6个月的随访,失访27例,失访率6.14%;死亡11例,死亡率2.50%;再次发病23例,再发率5.23%。2发病后2周、1个月、3个月、6个月的疲劳得分分别为(3.53±1.57)、(3.61±1.44)、(3.59±1.51)、(3.57±1.48),卒中后疲劳发生率分别为36.8%、37.7%、33.3%、30.6%,随时间呈现出逐渐下降趋势。3卒中后疲劳的影响因素3.1发病后2周内卒中后疲劳的影响因素:性别(OR=0.543,95%CI=0.326~0.905)、卒中前锻炼(OR=0.470,95%CI=0.287~0.769)、卒中前疲劳(OR=3.173,95%CI=1.652~6.094)、MRS评分≥2(OR=2.481,95%CI=1.475~4.171)、卒中后抑郁(OR=2.383,95%CI=1.445~3.929)、入院血糖(OR=1.231,95%CI=1.040~1.458)。3.2发病后1个月卒中后疲劳的影响因素:居住地(OR=0.455,95%CI=0.278~0.744)、卒中前锻炼(OR=0.574,95%CI=0.354~0.933)、卒中前疲劳(OR=2.926,95%CI=1.544~5.545)、MRS评分≥2(OR=2.483,95%CI=1.506~4.094)、卒中后抑郁(OR=2.846,95%CI=1.748~4.635)。3.3发病后3个月卒中后疲劳的影响因素:卒中前疲劳(OR=2.732,95%CI=1.435~5.167)、MRS评分≥2(OR=2.511,95%CI=1.519~4.149)、疼痛(OR=2.738,95%CI=1.296~5.791)、卒中后抑郁(OR=2.749,95%CI=1.678~4.503)。3.4发病后6个月卒中后疲劳的影响因素:卒中前疲劳(OR=2.405,95%CI=1.261~4.588)、MRS评分≥2(OR=2.162,95%CI=1.317~3.550)、疼痛(OR=2.656,95%CI=1.204~5.859)、卒中后抑郁(OR=3.141,95%CI=1.885~5.236)、消极应对方式得分(OR=1.790,95%CI=1.144~2.800)。结论1缺血性脑卒中患者发病后2周、1个月、3个月、6个月的卒中后疲劳发生率随时间呈现逐渐下降的趋势。2卒中前锻炼是缺血性脑卒中患者发病后2周和1个月卒中后疲劳的保护因素;高血糖是发病后2周卒中后疲劳的危险因素;中度及以上程度的疼痛是发病后3个月及6个月卒中后疲劳的危险因素;消极应对方式得分是发病后6个月卒中后疲劳的危险因素,提示改善应对方式可能是管理卒中后疲劳的一个新方向。卒中前疲劳、卒中后抑郁、存在明显残障(MRS评分≥2分)是发病后2周、1个月、3个月、6个月卒中后疲劳的共同危险因素,说明在脑卒中患者发病后6个月内这三个危险因素持续存在,提示医护人员应尽早鼓励患者积极治疗卒中前疲劳相关疾病、改善心理卫生、促进躯体功能恢复。
[Abstract]:Objective The purpose of this study was to investigate the incidence of fatigue in 2 weeks,1 month,3 months and 6 months after the onset of the first-episode ischemic stroke, and to analyze the influencing factors of post-stroke fatigue at different time points. The aim of this paper is to develop targeted interventions based on the influencing factors of different time points, and to provide the theoretical basis for relieving the fatigue of the patients. Methods This study was an investigative study. According to the inclusion and exclusion criteria of the study object,440 patients with ischemic stroke from October 2015 to May 2016 in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University were selected as the subject of study. Baseline survey was completed within 2 weeks after the patient was admitted. The survey included socio-demographic data, post-stroke fatigue and its clinical-related factors (severity of the disease, blood biochemical indicators, pain, post-stroke depression, sleep quality, coping style, etc.). The post-stroke fatigue status of the patient was assessed using a fatigue severity gauge. The influence factors of post-stroke fatigue were studied by subjective data, scale assessment and objective data. Follow-up surveys were conducted for 1 month,3 months, and 6 months after stroke, including post-stroke fatigue, MRS score, pain, post-stroke depression, sleep quality, and coping style scores. The statistical analysis of the data was carried out using the SPSS17.0 statistical software package. The statistical description of the data was carried out by means of the standard deviation, frequency and percentage of the average number; the single factor analysis of the fatigue was carried out by the two independent samples t-test by using the two-step test, the Kruskal-Wallis non-static test and the two independent samples t-test; The multi-factor analysis of the fatigue-influencing factors was carried out by logistic regression analysis, and the statistical significance was found in P0.05. Results A total of 440 cases of first-time ischemic stroke were included in this study. The average age was 62.43 and 12.09 years, among which 59.5% and 91.1% were married. At the time of admission, the patients with mild cerebral ischemia (3score of NIHSS) accounted for 62.9%, 33.9% of the patients with no significant disability (MRS2 score) and (6.08 to 1.51) mmol/ L. After 6-month follow-up,27 cases were lost to follow-up, and the rate of failure to follow-up was 6.14%,11 cases of death, 2.50% of death rate,23 cases of re-occurrence and 5.23%, respectively. The fatigue scores were 3.53 (1.57), (3.61-1.44), (3.59-1.51), (3.57-1.48) in 2 weeks,1 month,3 months and 6 months after the onset of the disease. The incidence of post-stroke fatigue was 36.8%, 37.7%, 33.3% and 30.6%, respectively. The influence factors of post-stroke fatigue were: gender (OR = 0.543,95% CI = 0.326-0.905), pre-stroke exercise (OR = 0.470,95% CI = 0.287-0.769). Pre-stroke fatigue (OR = 3.173,95% CI = 1.652-6.094), MRS score:2 (OR = 2.481,95% CI = 1.475-4.171), post-stroke depression (OR = 2.383,95% CI = 1.445-3.929), admission blood glucose (OR = 1.231,95% CI = 1.040-1.458), pre-stroke exercise (OR = 0.455,95% CI = 0.278-0.744), pre-stroke exercise (OR = 0.574,95% CI = 0.354-0.933), prestroke fatigue (OR = 2.926,95% CI = 1.544-5.545), MRS score = 2 (OR = 2.483,95% CI = 1.506-4.094), Post-stroke depression (OR = 2.846,95% CI = 1.748 to 4.635). 3.3 The effect of post-stroke fatigue in 3 months after onset: pre-stroke fatigue (OR = 2.732,95% CI = 1.435-5.167), MRS score:2 (OR = 2.511,95% CI = 1.519-4.149), pain (OR = 2.738,95% CI = 1.296-5.791), post-stroke depression (OR = 2.749,95% CI = 1.268-4.503), and post-stroke depression (OR = 2.749,95% CI = 1.261-4.588), MRS score:2 (OR = 2.162,95% CI = 1.261-4.550), pain (OR = 2.162,95% CI = 1.317-3.550), pain (OR = 2.656,95% CI = 1.204-5.859), Post-stroke depression (OR = 3.141,95% CI = 1.885-5.236), negative coping style score (OR = 1.790,95% CI = 1.144-2.800). Conclusion The incidence of post-stroke fatigue in patients with ischemic stroke is decreasing with time in 2 weeks,1 month,3 months and 6 months, and the pre-stroke exercise is the protective factor of post-stroke fatigue in 2 and 1 months after the onset of ischemic stroke. Hyperglycemia is a risk factor for post-stroke fatigue after 2 weeks of onset; moderate and higher pain is a risk factor for post-stroke fatigue in 3 months and 6 months after onset; the negative coping style score is a risk factor for post-stroke fatigue in the 6-month post-onset stroke, It is suggested that the improvement of coping style may be a new way to manage post-stroke fatigue. The pre-stroke fatigue, post-stroke depression, and the presence of a significant disability (MRS score of 2 scores) were common risk factors for post-onset fatigue in 2 weeks,1 month,3 months, and 6 months, indicating that the three risk factors continued to exist within 6 months of the onset of stroke patients, It is suggested that the medical staff should encourage the patients to actively treat the pre-stroke fatigue related diseases, improve the mental health and promote the recovery of the physical function.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R743.3

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