缺血性脑卒中所致假性延髓麻痹患者短期预后的相关影响因素

Influential factors for short-term prognosis in patients with ischemic stroke-induced pseudobulbar palsy

目的:回顾性分析缺血性脑卒中所致假性延髓麻痹短期预后的相关影响因素,筛选出预测指标,以指导早期干预措施和治疗方案。方法:选择2004-05/2005-04在哈尔滨医科大学附属第二医院神经科住院的急性缺血性脑卒中患者中发生假性延髓麻痹的患者126例,均自愿参加观察。选择患者的性别、年龄、既往史(高血压史、糖尿病史、冠状动脉粥样硬化性心脏病史、脑卒中次数、吸烟史、饮酒史)、入院时检查(血压、血糖、胆固醇、三酰甘油、纤维蛋白原)、假性延髓麻痹类型、偏瘫程度、合并感染、合并电解质紊乱、头CT或MRI病灶数18个因素进行单因素分析;应用Logistic模型分析影响疾病短期预后的相关因素和预测因素。入院后正规治疗20d,第21天评价短期预后。显效为假性延髓麻痹症状基本消失,能顺利进食流质食物;好转为能顺利进食固体食物,但进食流质食物仍有呛咳。短期预后好为显效和好转的患者,短期预后差为无变化、恶化和死亡的患者。结果:患者126例全部进入结果分析,无脱落。①单因素分析结果:短期预后好组患者84例,短期预后差组患者42例,单因素分析结果显示两组患者有7个因素差异具有显著性意义(P<0.05),包括年龄、脑卒中次数、假性延髓麻痹类型、偏瘫程度、合并感染、合并电解质紊乱、CT或MRI病灶数。②Logistic模型分析结果:合并感染、完全性假性延髓麻痹、年龄大、CT或MRI病灶数多、合并电解质紊乱是短期预后差的具有预测意义的影响因素。结论:患者的年龄、假性延髓麻痹类型、合并感染、合并电解质紊乱、CT或MRI病灶数在一定程度上能够预测缺血性脑卒中所致假性延髓麻痹短期预后的发展趋势。对有此趋势的患者应早期干预、充分救治。

AIM： To retrospectively analyze the relatively influential factors on shortterm prognosis of pseudobulbar palsy resulted from ischemic stroke, and to screen out the predictive parameters so as to instruct the early interventional measure and therapeutic regimen. METHODS： Totally 126 patients with acute ischemic stroke, who got pseudobulbar palsy hospitalized at Department of Neurology, Second Affiliated Hospital, Harbin Medical University from May 2004 to April 2005, were enrolled. They all joined the investigation voluntarily. Sex, age, history of past （history of hypertension, history of diabetes mellitus, history of coronary atherosclerotic heart disease, times of stroke, history of smoking, history of drinking）, admission examination （blood pressure, blood glucose, cholesterol, triacylglycerel, metaglobulin）, type of pseudobulbar palsy, severity of hemiparalysis, concurrent infection, concurrent electrolyte disturbances, the number of the lesions in head on CT or MRI were determined with single factor analysis. Related factor and predictive factor affecting short-term prognosis were analyzed with Logistic model. Regular treatment was 20 days after hospital admission, and at the 21^th day shortterm prognosis was assessed. Remarkable effect indicated that the pseudobulbar palsy nearly disappeared, able to eat fluid food smoothly. Relative improvement indicated able to eat solid diet, but bucked when ate fluid food. Good short-term prognosis was for patients with remarkable effect and relative improvement. Bad short-term prognosis was for patients with no change, aggravation and death. RESULTS： A total of 126 patients were involved in the result analysis, without drop out. ①Single factor analysis： The 84 cases were with good short-term prognosis and 42 cases were with bad short-term prognosis. Single factor analysis showed that there were significant difference in 7 factors of all （P 〈 0.05）, which were age, times of stroke, type of pseudobulbar palsy, severity of hemiparalysis, concurrent infection, concurrent electrolyte disturbances, the number of the lesions on CT or MRI. ②Logistic model analysis： It showed that the predictive relative factors which would worsen the shortterm prognosis included concurrent infection,total pseudobulbar palsy, old age, more lesions on CT or MRI and concurrent electrolyte disturbances. CONCLUSION： The age of the patient, type of pseudobulbar palsy, concurrent infection, concurrent electrolyte disturbances and the number of the lesions on CT or MRI can be valuable predictive parameters to the shortterm prognosis of the disease to some extent. Knowing these predictors may be helpful on early management and treatment for those patients.