急性脑梗死神经功能缺损和3个月结局的牛津郡社区卒中项目分型评估

Evaluation of acute neurologic impairment and 3 month outcome of cerebral infarction by Oxfordshire Community Stroke Project classification

目的 分型观察急性脑梗死患者神经功能缺损和 3个月结局的差异。方法 前瞻性连续收集首次发病的脑梗死患者 14 6例 ,分 4个牛津郡社区卒中项目 (OCSP)亚型比较急性期神经功能缺损评分、3个月的病死率、复发率和日常生活活动 (ADL)能力评分。结果 神经功能缺损评分依次为全前循环梗死(TACI) >部分前循环梗死 (PACI) >后循环梗死 (POCI) >腔隙性梗死 (LACI) ,TACI与另 3个亚型之间 ,PACI与POCI、LACI之间的差异有极显著性意义 (P <0 .0 0 0 5 )。TACI的病死率为 42 % ,PACI为 7.6% ,LACI为 2 % ,POCI为 0 ,差异有极显著性意义 (P <0 .0 0 0 5 )。LACI的复发率为 2 % ,PACI为 1.5 % ,TACI和POCI无复发 ,差异无显著性意义 (P >0 .0 5 )。存活者中 ,TACI 3个月的ADL为重度依赖 ,另 3个亚型均为轻度依赖 ,差异有极显著性意义 (P <0 .0 0 0 5 )。结论 OCSP分型可以评价脑梗死的急性神经功能缺损和

Objective To observe difference among the different types of ischemic stroke patients as classified by the Oxfordshire Community Stroke Project (OCSP) classification, in terms of acute neurologic impairment and 3 month outcome after onset of cerebral infarction. Methods One hundred and forty six consecutive admission of patients with first ever acute cerebral infarction(onset time 30min～15d) were prospectively identified and classified as 4 OCSP subtypes to compare acute neurologic impairment score and 3 months fatality rate, recurrence rate and score of activities of daily living (ADL). Results The level of neurologic impairment was TACI>PACI>POCI>LACI. The statistical difference of neurologic impairment between TACI and other 3 subtypes and that between PACI and POCI or LACI was significant( P <0.0005), but no statistically significant difference between LACI and POCI was revealed. Fatality rate of TACI was 42% (8/19), without recurrence stroke; the fatality rate of PACI was 7.6%(5/66), and its recurrence rate was 1.5% (1/66); all the LACI patients survived in acute period, but one patient recurred massive cerebral infarction at 50 days after onset, and died 2 days after recurrence.Both fatality rate and recurrence rate of LACI were 2% (1/45). None of the 16 POCI patients died and recurred. The fatality rate among the 4 subtypes was significantly different( P <0.0005). However, the statistical difference among their recurrence rate was not significant. Among all survivors, the 3 month ADL of TACI was critical dependence, while that of other subtypes was light dependence( P <0.0005). However, Barthel index of LACI was the highest, PACI's was smaller. Conclusion The OCSP classification can be used to evaluate difference of acute neurologic impairment and 3 month outcome of patients with cerebral infarction.