重症急性脑梗死患者并发症的早期监测

Monitoring of Medical Complications in Acute Cerebral Infarction

目的探讨入住神经内科监护病房的重症脑梗死患者2周内并发症的发生率和发生时间,以期为早期诊治提供依据。方法 70例急性脑梗死患者在发病72 h内入住监护病房,入院后第2、4、7、14天评价15项常见并发症的发生情况。结果发病2周内,卒中进展或复发、泌尿系感染、心律失常、发热、肺部感染、应激性溃疡、胃肠功能不全和低蛋白血症8种并发症最常见(发生率>10%),其中发热和肺部感染的发生率最高,在第7天分别达到44.29%和77.14%。发生时间的特征:卒中进展或复发、泌尿系感染主要发生在起病2 d内;心律失常、发热、肺部感染和应激性溃疡的发生率在病后1周达高峰;胃肠功能不全和低蛋白血症主要发生在发病后1～2周。重度组患者易发生多种并发症,尤以卒中进展或复发、缺血性心脏病、发热、肺部感染和低蛋白血症为著,与轻度组、中度组比较差异有统计学意义(P<0.05)。结论重症脑梗死患者易发生发热、肺部感染、进展性卒中等并发症,大多数并发症在病后7 d内达高峰,入院时卒中的严重程度是导致并发症发生的重要危险因素。

Objective To examine the frequency and timing of medical complications in acute stage of critical stroke patients treated in a neuro-ICU within two weeks to provide basis for early diagnosis.Methods Seventy acute stroke patients were admitted into neuro-ICU and followed up with assessments of 15 prespecified complications during the first two weeks.Results During the first two weeks,the most common complications（frequency 10%） were progression or recurrence of stroke,urinary tract infection,arrhythmia,fever,chest infections,irritable ulcer,gastro-intestinal dysfunction and malnutrition,among which the fever and chest infections had the highest incidence,reaching 44.29% and 77.14%.During the 2-week follow-up,progression or recurrence of stroke and urinary tract infection mostly occurred in the first two days;arrhythmia,fever,chest infections and irritable ulcer reached peak at one week;gastro-intestinal dysfunction and malnutrition mostly developed at one to two weeks.The most severe patients tended to develop much more complications such as progression or recurrence of stroke,myocardial infarction,fever,chest infections and malnutrition.The difference of complication levels in severe patients was significantly higher than that in wild patients and middle severe patients（P 0.05）.Conclusion This prospective study shows that progression or recurrence of stroke,fever and chest infections are common complications in acute stage of critical ischemic stroke patients.Most complications occur during the first week,and stroke severity is the most important risk factor.