老年急性脑卒中院内死亡相关危险因素分析

Risk Factors of In-hospital Death after Acute Stroke among Elderly Patients

目的分析导致老年急性脑卒中患者院内死亡的相关危险因素,以利于对临床老年脑卒中患者的治疗及降低其院内死亡率。方法收集我科2009年1月—2010年12月治疗的老年急性脑卒中患者778例。采集患者入院时的临床特征、既往史、影像学检查等资料,以住院30 d内死亡为结局将患者分为死亡组(43例)和存活组(735例),并对影响老年急性脑卒中患者院内死亡的危险因素进行Logistic多元逐步回归分析。结果死亡组的年龄,卒中类型,既往糖尿病史、冠心病史和脑卒中史,入院时美国国立卫生研究院卒中量表(NIHSS)和Glasgow评分,鼻饲管、导尿管和中心静脉置管,并发肺部感染、尿路感染、脑心综合征、消化道出血和下肢静脉血栓形成共15项危险因素与生存组比较,差异均有统计学意义(P<0.05)。调整年龄及性别因素后,经Logistic回归分析结果显示:糖尿病史、冠心病史、入院时NIHSS高、鼻饲管、导尿管、中心静脉置管、并发肺部感染、尿路感染、脑心综合征、消化道出血、下肢静脉血栓形成共11项危险因素OR值>1,为老年急性脑卒中患者院内死亡的危险因素。Glasgow评分高为保护性因素〔OR=0.65,95%CI(-7.26,0.82)〕。进一步调整其他危险因素后,入院时Glasgow评分高亦为保护性因素〔OR=0.32,95%CI(-6.43,0.53)〕。合并肺部感染〔OR=6.57,95%CI(2.16,26.79)〕、脑心综合征〔OR=3.18,95%CI(2.07,9.55)〕、消化道出血〔OR=3.42,95%CI(1.98,7.86)〕均为急性脑卒中死亡的独立危险因素。结论老年急性脑卒中患者的院内死亡有多种危险因素。独立危险因素为入院时Glasgow评分低、合并肺部感染、脑心综合征和消化道出血,故应积极预防和治疗急性脑卒中合并症。

Objective To analyze the risk factors of in-hospital death after acute stroke among elderly（more than 60 years） patients.Methods The clinical data including clinical manifestations,previous history,and imaging findings of 778 elderly patients with acute stroke in our hospital from January 2009 to December 2010 were retrospectively analyzed.They were divided into death group and survival group based on the death occurred within 30 days after admission.The potential risk factors of death after acute stroke were analyzed using Logistic multiple regression method.Results Compared with the survival group,the stroke pattern,previous histories of diabetes,coronary heart disease,and stroke,NIHSS and Glasgow scores at admission,application of nasogastric tubes,catheter,and central venous catheter,and concurrent lung infection,urinary tract infection,brain-heart syndrome,gastrointestinal bleeding,and deep venous thrombosis of lower limbs showed significantly differences in the death group（all P〈0.05）.After the age,gender were adjusted,the histories of diabetes,coronary heart disease,NIHSS and Glasgow scores at admission,invasive procedures,and concurrent lung infection,urinary tract infection,brain-heart syndrome,and gastrointestinal bleeding were independent risk factors of death after acute stroke in elderly patients.Conclusion In-hospital death after acute stroke among elderly patients have multiple risk factors.The independent risk factors include high Glasgow score at admission,lung infections,brain-heart syndrome,and gastrointestinal bleeding.Therefore,the complications associated with acute stroke should be actively managed.