神经科重症监护病房中急性脑卒中患者死亡危险因素的分析

Analysis of the death risk factors in patients with acute stroke in the neurological intensive care unit

目的探讨神经科重症监护病房（NICU）中急性脑卒中患者死亡的危险因素。方法归纳NICU中137例急性脑卒中患者的临床资料,对多种危险因素进行单因素及多因素Logistic回归分析。结果单因素分析显示,年龄、昏迷、高热、肺部疾病、房颤/心脏扩大、卒中史、机械通气、脑中线移位、入院时血糖水平、急性生理与慢性健康评估（APACHE）Ⅱ评分、鼻饲管和导尿管及合并肺部感染在死亡组和生存组之间差异有统计学意义（P〈0.05-0.01）。多因素Logistic回归分析显示,昏迷、高热、肺部感染、机械通气以及有房颤/心脏扩大者与急性脑卒中死亡关系最为密切。结论昏迷、高热、肺部感染、机械通气及合并房颤/心脏扩大是NICU中急性脑卒中患者死亡的重要危险因素。

Objective To investigate the risk factors of death in patients with acute stroke in the neurological intensive care unit（ NICU ）. Methods The clinical data of 137 patients with acute stroke in the NICU were induced. The risk factors were analysed by univariate and multi-variate Logistic regression analysis. Results There were 13 risk factors including age, coma, hyperpyrexia, pulmonary disease, atrial fibrilation/cardiac dilatation, stroke history, mechanical ventilation, brain midline shift, initial serum glucose, APACHE Ⅱ scores, feeding tube, urethral catheter and concurrent pulmonary infection which had statistical significance between the death group and survive group,by univariate analysis （P 〈 0. 05 -0.01 ）. Multi-variate Logistic regression analysis further demonstrated 5 factors which had closely correlated with the death of acute stroke, including coma, hyperpyrexia, atrial fibrilation/ cardiac dilatation, mechanical ventilation and concurrent pulmonary infection. Conclusions The most important risk factors of death in patients with acute stroke in NICUs are coma, hyperpyrexia, pulmonary infection, atrial fibrilation/ cardiac dilatation and mechanical ventilation.