脑梗死存活率影响因素的前瞻性研究

A prospective study on factors influencing long-term survival after cerebral infarction

目的研究脑梗死后痴呆对存活率的影响。方法对619例急性脑梗死患者进行人文因素、血管因素、卒中特征资料收集和神经心理检查。在入院及卒中后3个月按美国精神病学会DSM-Ⅳ标准对卒中患者进行痴呆诊断,随访2年,分析痴呆患者的存活率及死亡相关预测因素。结果 卒中后3个月共有146例(23.6％)患者被诊断为痴呆,其中39例为卒中前痴呆,107例为卒中相关痴呆。随访(19.4±8.3)个月,卒中后痴呆患者存活率为49.3％,随访(21.3±9.1)个月,卒中相关性痴呆存活率为53.7％,非痴呆患者存活率为92.0％。多因素分析显示,卒中后痴呆与死亡明显相关,脑梗死后痴呆病死率的独立危险因素是年龄、心房颤动、卒中史、日常生活能力评分、卒中后痴呆和卒中相关痴呆。结论痴呆降低卒中患者存活率,并可作为卒中后存活的一个预测因素。

Objective To investigate effect of dementia on survival rate after ischemic stroke in China.Methods Neurological, neuropsychological and functional assessment was performed in 619 patients with ischemic stroke. Dementia was diagnosed on admission and 3 months after onset of stroke according to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. All patients were planned to follow up for 2 years after stroke, the proportion of surviving patients with and without dementia and the relative risk of mortality were calculated.Results 146 patients (23.6%) were diagnosed as dementia 3 months after stroke, 39 of whom were pre-stroke dementia and 107 were stroke-related dementia. The cumulative proportion of surviving cases was 49. 3% in patients with post-stroke dementia after a median follow-up period of 19.4±8. 3 months, 53.7% in patients with stroke-related dementia after a median follow-up period of 21.3±9.1 months, and 92.0% in patients without dementia. Multivariate analysis found that the mortality was significantly related with dementia.The independent risk factors of fatality of dementia after cerebral infarction were age, Barthel index, atrial fibrillation and previous stroke. Conclusions Survival is reduced by dementia after stroke. Dementia is a predictor of mortality in patients after stroke.