缺血性中风患者发病3个月致残因素初探

Preliminary Study on Cause of Disability in Patients with Ischemic Apoplexy

目的:研究中医院缺血性中风住院患者发病3个月的致残因素。方法:客观、实时、全面、动态连续地采集缺血性中风患者的临床信息。以发病3个月B I≤60分作为致残标准,探索缺血性中风患者发病3个月的致残因素。结果:257例缺血性中风患者进入本研究,其中B I>60分215例(83.7%),B I≤60分42例(16.3%)。单因素分析显示,患者发病时的年龄,既往糖尿病病史,入院时(发病72h内)的OCSP分型,入院时(发病72h内)的神经功能缺损程度(NIHSS评分),急性期头颅核磁DW I相显示的病灶大小,发病7d内出现的嗜睡、表情淡漠、反应迟钝、目偏不瞬、肢体松懈瘫软、肢体拘急、手肿胀、痰难咯出、咳嗽、鼻鼾、微热、小便失禁,但欲寐、舌质老、舌干、薄苔、厚苔、糙苔,发病28d内合并感染,使用降纤治疗及使用醒脑开窍的中成药与发病3个月残疾的发生有关。Logistic回归分析显示,入院时(发病72h内)的神经功能缺损程度(NIHSS评分)、发病7d内出现目偏不瞬、发病28d内合并感染是缺血性中风患者发病3个月的独立致残因素,而发病7d内舌苔为薄苔是缺血性中风患者发病3个月致残的保护因素。

Objective： To find factors associated with handicap in cerebral infarction on the 3rd month after attack. Methods：Clinical information were collected daily in 14 days after attack. Admission （in 72 hours after attack） National Institutes of Health Stroke Scale （NIHSS）, NIHSS on the 7th, 14th, 28th,and the third month were also collected. Bathel Index（BI） was used to assess the ability of daily life on the third month. The patients whose BI ≤60 are considered to be handicapped. Results：A total of 257 patients were studied. There were significant differences in age, Past history of diabetes, admission OCSP types,admission NIHSS, acute phase of head magnetic resonance imaging showed the lesion relative to the size of DWI,these symptoms emerging in 7 days after attack somnolence,apathetic expression, slow mental reaction, gaze palsy, limbs limp, limb rigidity, hand swelling, sputum difficult to expectorate, cough, snore, low fever, incontinence of urine, dry tongue, thin fur, thick fur, dry fur, rough fur, infection within 28 days,treatment defibrase within 28 days and inducing resuscitation PCm within 28 days. In our muhivariable logistic regression Admission （in 72 hours after attack） NIHSS, gaze palsy in 7 days after attack and infection within 28 days are independently associated with handicap while thin fur in 7 days after attack is independently protective factor.