急性脑梗死的预后因素分析及预防措施

Analysis of factors related to the prognosis of acute cerebral infarction and preventive measures.

[目的 ] 探讨引起急性脑梗死 (ACI)死亡的危险因素及相应的各级预防措施。 [方法 ] 回顾性分析 2 77例经临床和CT诊断为急性脑梗死的病例。对其年龄 ,性别 ,作为中风危险因素的有关病史 ,起病到就诊时间 ,起病时的意识状况 ,血压水平 ,血糖水平 ,血肌酐水平以及病程中心电图改变 ,肺部感染 ,体温 ,CT所见病灶部位等资料用SPSS统计软件进行了描述性和Logistic多元回归分析。 [结果 ] 高血压 ,糖尿病及心脏病患者在脑梗死病人中占很大比例。年龄 ,起病时意识障碍 ,肺部感染 ,应激性溃疡 ,血肌酐水平增高 ,心电图改变 (尤其是房颤 ,心肌缺血 )以及梗塞部位等变量在Logistic多元回归中有统计学显著差异 (P <0 .0 5 )。[结论 ] 控制血压和血糖 ,治疗感染 ,预防应激性溃疡的发生 ,保护好心肾等重要脏器的功能 ,可能会降低ACI的病死率。脑梗死的康复期 ,仍应控制危险因素 ,减少再梗死的发生率。

Objective] To investigate the factors that may relate to the prognosis (death or not) of acute cerebral infarction (ACI) and possible preventive measures. [Method] 277 cases of acute cerebral infarction that was definitely diagnosed clinically and by CT scan were studied. All the variables that may relate to the prognosis of the disease including age, gender, diseases that were the risk factors of stroke, time lag from onset to treatment, conscienceness at onset,blood pressure, blood glucose, serum creatinine, change of ECG after onset of the disease, pulmonary infection, body temperture and location of infarction by CT scan, were analyzed descriptively and also by multiple logistic regression with SPSS statistics software. [Results] The prevalence of hypertension, diabetes and heart disease were much higher among pateints with ACI than that of the general polulation. Age,unconscienceness,pulmonary infection, acute stress ulcer, high creatinine level, ECG change (especially atrial fibrillation and cardiac ischemia) and the location of infarction were related to the death of ACI with statistically significant correlation coefficient (P<0.05).[Conclusion] Good control of blood pressure and blood glucose, adequate treatment of heart disease may decrease the incidence of ACI as the primary prevention. During the acute phase of treatment of ACI, treatment and control of infection, prevention of acute stress ulcer, maintenance of important organ function like heart and kidney will decrease the mortality of ACI significantly.During the rehabilitation phase of the disease, control of all the risk factors is still important in decreasing the incidence of re-infarction.