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醫(yī)學(xué)免費(fèi)論文:缺血性卒中功能預(yù)后及其影響因素的回顧性研究
【摘要】 目的 對缺血性卒中患者進(jìn)行隨訪，觀察功能預(yù)后情況并對其影響因素進(jìn)行分析。方法 回顧性收集2002年1月～2005年6月第四軍醫(yī)大學(xué)西京醫(yī)院神經(jīng)內(nèi)科確診的連續(xù)性缺血性卒中病例作為研究對象，采用電話、信訪等方式隨訪，改良Rankin評分為結(jié)局指標(biāo)，2006年1月完成隨訪工作。對影響功能預(yù)后的因素進(jìn)行單因素和多元logistic回歸分析。結(jié)果 846例缺血性卒中病例中，不符合納入標(biāo)準(zhǔn)169例，排除60例，資料不全者128例。隨訪時間最長47個月，失訪55例(11.2%)，最終納入分析434例，其中預(yù)后良好者244例(56.2%)，預(yù)后不良者190例(43.8%)。單因素及多元logistic回歸分析顯示，年齡(OR=3.51;95% CI:2.10～5.85)、教育程度(OR=0.69;95% CI:0.57～0.83)、腦卒中史(OR=2.48;95% CI:1.44～4.27)、NIHSS評分(OR=2.62;95% CI:1.58～4.33)和缺血性腦卒中預(yù)后不良明顯相關(guān)。結(jié)論 高齡、教育程度低、有腦卒中史、NIHSS評分高是不良預(yù)后的主要影響因素。
【關(guān)鍵詞】 腦血管意外; 回顧性研究; 預(yù)后醫(yī).學(xué).全.在.線gydjdsj.org.cn
Retrospective study of functional prognosis and influential factors of ischemic stroke
LIU Xuedong, WANG Bo, LIU Ya, ZHAO Gang, WU Zhongliang, LIU Zhirong, Lü Yali, XU Dezhong
1.Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China; 2.Department of Epidemiology, Fourth Military Medical University, Xi'an 710032, China; 3.Outpatient Department, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, China; 4.The Central Hospital of Xi'an Railway Bureau, Xi'an 710054, China
【Abstract】 Objective To observe the functional prognosis and to analyze the influential factors of ischemic stroke patients. Methods Continuous ischemic stroke cases were retrospectively collected in the Neurology Department in Xijing Hospital of the Fourth Military Medical University from January 2002 to June 2005. Followup was done through phone or mail and mRS score made as the primary outcome. The followup was finished in January 2006. The influential factors were analyzed by monovariant and multivariant logistic regression. Results 846 continuous cases were collected, 169 of which did not meet the inclusion criteria; 60 cases were excluded; 128 cases had missing data. The followup time was up to 47 months, and 55 cases (11.2%) were lost. Thus, the remaining 434 patients were analysized. Monovariant and multivariant logistic regression analyses showed that the poor outcome was associated with age (OR=3.51; 95% CI:2.10～5.85), educational level (OR=0.69; 95% CI:0.57～0.83), stroke history (OR=2.48; 95% CI:1.44～4.27), and NIHSS total scores (OR=2.62; 95% CI:1.58～4.33). Conclusions The results suggest that older age, lower educational level, having stroke history, and higher NIHSS total scores were influential factors of functional outcome of ischemic stroke.
【Key words】 Cerebrovascular accident; Restrospective studies; Prognosis (Chin J Dis Control Prev 2008，12(1)：1720)
腦卒中在我國疾病死亡原因中已排第2位，其中缺血性卒中占60%～80%。隨著人口老齡化的加劇，腦卒中已成為威脅老年人健康的重要危險因素。卒中預(yù)后是臨床醫(yī)生和患者均非常關(guān)心的問題，目前，國外在此方面進(jìn)行了大量研究，證實許多因素與預(yù)后有關(guān)，如性別、年齡、卒中嚴(yán)重程度及一些實驗室指標(biāo)，但目前國內(nèi)有關(guān)腦卒中的預(yù)后研究較少，且樣本量較小，許多研究并未區(qū)分出血性腦卒中和缺血性腦卒中。本研究采用以醫(yī)院為基礎(chǔ)的回顧性研究，確定預(yù)測缺血性腦卒中功能預(yù)后的因素。
