住院过程中缺血性卒中病情进展的相关因素分析

Analysis of the relative factor of progression in ischemic stroke during hospitalization

目的 明确引起缺血性卒中住院过程中病情进展的相关因素及各种危险因素的危险程度,在规范化治疗框架下树立急性缺血性卒中个体化治疗的理念.方法 回顾性分析638例入院时神经功能缺损评分在25分及25分以下的缺血性卒中患者在住院治疗过程中病情的演变情况.患者入院后每3 d进行一次神经功能缺损评分,累计增加10分以上者认定为病情进展,并对影响病情演变的相关因素进行分析,评价不恰当的治疗措施对缺血性卒中病情演变的影响程度.结果 638例患者中病情进展256例,占40.13%（256/638）;其中经CT证实为进展性卒中64例（25.00%,64/256）,被认为是治疗措施不当192例（75.00%,192/256）.应用脱水剂和血管扩张剂、单纯收缩压降低[急性期应用降压药致使收缩压低于l10mmHg（1mmHg=0.133 kPa）]、高脂血症、糖尿病对卒中进展影响较大（P＜0.05）,特别是多种危险因素同时存在时影响尤为突出.结论 急性缺血性卒中治疗的关键是保护缺血半暗带区细胞功能,避免或减轻卒中后脑细胞损伤的瀑布效应发生,尽快恢复正常代谢,所有影响脑灌注、脑耗氧的治疗措施均可认为是病情进展的危险因素.不恰当的治疗措施使卒中病情进展例数明显增加,缺血性卒中的治疗要规范化,更要个体化,要结合患者的实际情况,掌握好各种治疗手段的适应证及时机.

Objective To know the relative factor of progression in ischemic stroke during hospitalization and the risk degree of the risk factor, establish the individuation treatment system in acute ischemic stroke under the framework of standardization. Methods Six hundred and thirty-eight acute ischemic stroke patients＇ condition changes whose neural function depletion degree scored not more than 25 at that time of hospitalization were retrospectively analyzed. Scored once every 3 days. The gaining scores total to 10 to be determined stroke was progressed. Analyzed every influencing factor,and evaluated their risk degree to progressing stroke. Results Total 256 cases [40.13% （256/638）] state of illness turned to exacerbation,64 cases [25.00% （64/256）] were confirmed progressing stroke,CT showed foci extended; 192 cases [75.00%（192/256）] who only showed symptoms and physical signs dilation were confirmed to have incorrect treatment. Dehydrator and vasodilator agent application, simple systolic blood pressure decreasing [〈 110 mm Hg （1 mm Hg =0.133 kPa）], hyperlipoidemia, diabetes mellitus were the important factors for progressing stroke （P〈 0.05）,especially when all risk factors appeared on 1 case. Conclusions The key of treatment is to protect half backspaced cerebral cell＇s normal functions in acute ischemic stroke, keep normal metabolism,avoid or control the water fall effect occurrence. If every influencing factor is disadvantage to cerebral cell＇s perfusion, oxygen consumption should be confirmed the risk factors in the progress of ischemic stroke. Not only know important of the standardization treatment, but also know the interest of individuation treatment, which combined with the patient＇s condition closely.