急性缺血性卒中治疗现状及TOAST分型与预后相关性研究

发布时间：2018-02-16 16:26

本文关键词： 急性缺血性梗死 TOAST分型真实世界　出处：《河南中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:1.分析目前真实世界中急性缺血性卒中急性期治疗现状;2.分析TOAST分型对治疗脑卒中急性期预后的影响。方法:连续性记录2015年3月至2016年1月因急性缺血性卒中在河南中医学院第一附属医院和郑州市中心医院住院治疗患者,调查真实临床实践中急性缺血性脑中风患者的治疗方案、治疗结局、TOAST分型等,观察时间为90天,并对其结果进行统计学分析。结果:1.真实世界中患者接受溶栓治疗的仅占2.2%,83%的患者给予脑保护剂治疗,94%患者接受抗血小板治疗,联合治疗方案中以四联用药、五联用药的患者比例较高,其中用中药针剂+抗血小板药物+改善脑循环药物+神经保护剂的患者比例为36%,使用中药汤剂+中药针剂+抗血小板药物+改善脑循环药物+神经保护剂的患者为比例为26%,使用中药汤剂+中药针剂+抗血小板药物+神经保护剂的患者比例为24%。2.中医院与西医院治疗前性别、年龄、NIHSS评分无统计学差异(P0.05)。药物干预后出院时两组神经功能缺损(NIHSS)评分、神经功能缺损好转率、显效、效差均无统计学意义。药物干预后入院7天的基于中风病患者报告的临床结局评价量表(PRO)评分无统计学意义(P0.05),出院时两组PRO评分具有明显差异(P=0.0150.05)。3.TOAST分型各亚组性别、年龄无明显差异(P0.05);各亚型间出入院时NIHSS评分及其好转率进行比较显示:TOAST各亚型间患者入院时(P=0.0070.05)、出院时(P=0.0170.05)及好转率(P=0.0230.05)比较差异具有统计学意义。其中心源性栓塞(CE)组较其它组NIHSS评分最高且好转率最低,小动脉闭塞性卒中(SAO)组与CE组结果相反。临床疗效结果显示SAO明显好于其它组,临床治疗效果最好(P0.01);大动脉粥样硬化性卒中(LAA)疗效较CE、SOE好(P0.05);不明原因的缺血性卒中(SUE)疗效与LAA、其他原因引起的缺血性卒中(SOE)比较无明显差异(P0.05),CE与SOE、SUE比较临床效果最差有统计学意义(P0.01)。复发率示CE与各亚组比较复发率最高(P0.05)有统计学意义。结论:1、真实世界中溶栓患者的比例依旧偏低,联合用药以四联用药比例最高;2、中医药治疗对于改善患者PRO评分较单纯西医药治疗具有优势;3、TOAST分型中以小动脉闭塞性卒中疗效最好,心源性脑栓塞疗效最差且复发率高,可以作为预测性指标用于急性缺血性卒中治疗过程中。
[Abstract]:Objective 1. To analyze the current situation of acute ischemic stroke treatment in the real world 2. To analyze the influence of TOAST classification on the prognosis of acute stroke. Methods: from March 2015 to January 2016, continuous records of acute ischemic stroke were recorded. Stroke patients were hospitalized at the first affiliated Hospital of Henan College of traditional Chinese Medicine and Zhengzhou Central Hospital, To investigate the actual clinical practice of patients with acute ischemic stroke treatment plan, treatment outcome and toast classification, observation time is 90 days, In the real world, only 2.2% of the patients received thrombolytic therapy, and 94% of the patients received antiplatelet therapy. The proportion of patients treated with five drugs is relatively high. The proportion of patients with traditional Chinese medicine injection antiplatelet drugs to improve cerebral circulation drug neuroprotective agent is 36. Patients who use traditional Chinese medicine decoction Chinese medicine injection antiplatelet drug to improve cerebral circulation drug neuroprotective agent patients. The proportion of patients treated with traditional Chinese medicine decoction, traditional Chinese medicine injection, anti-platelet drugs and neuroprotective agents was 24. 2. Sex before treatment in traditional Chinese medicine hospital and western hospital. There was no significant difference in NIHSS score between the two groups (P 0.05). When the two groups were discharged from hospital after drug intervention, NIHSS score, the improvement rate of neurological impairment and the effect were significant. There was no significant difference in the efficacy between the two groups. There was no significant difference in PRO scores between the two groups at the time of discharge, and there was a significant difference between the two groups at the time of discharge. 3. There was a significant difference between the two groups in the sex of each subgroup according to the classification of stroke patients on the 7th day after admission, and the difference was significant between the two groups at the time of discharge. There was no significant difference in age (P 0.05), and the comparison of the NIHSS score and the improvement rate among the subtypes showed that there were significant differences between the two subtypes (P = 0.0070.05, P = 0.0170.05) and the improvement rate (P = 0.0230.05), among which the cardiac embolism (CEE) was a significant difference between the two subtypes (P < 0.05, P < 0.05), and a significant difference was found between the two subtypes (P = 0.0070.05, P = 0.0170.05) and the improvement rate (P = 0.0230.05). The NIHSS score of the group was the highest and the rate of improvement was the lowest. The results of SAO group were contrary to those of CE group, and the clinical results showed that SAO was better than other groups. The effect of clinical treatment was better than that of CE-SOE (P 0.05); the effect of ischaemic stroke of unknown cause was better than that of Lai and other causes of ischemic stroke. There was no significant difference between P0.05CE and SOESUE compared with SOESUE. The recurrence rate showed that CE had the highest recurrence rate compared with each subgroup (P0.05). Conclusion: 1, the proportion of thrombolytic patients in the real world is still low. The proportion of combined use of four drugs was the highest. Traditional Chinese medicine treatment was superior to western medicine in improving the PRO score of patients. In the classification of small artery occlusive stroke, the effect of cardiogenic cerebral embolism was the worst and the recurrence rate was high. It can be used as predictive index in the treatment of acute ischemic stroke.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.7

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