急性脑卒中与血浆渗透压水平关系的临床研究

Plasma Osmotic Pressure as A Predictor of Acute Stroke:An Clinical Study

目的探讨急性脑卒中与血浆渗透压水平的关系。方法选择2011年1月—2011年10月北京安贞医院神经内科住院的急性脑卒中患者423例,检测其入院时的血浆渗透压,分析与血浆渗透压水平相关的多种因素以及血浆渗透压水平对急性脑卒中预后的影响。结果急性脑卒中合并各疾病的血浆渗透压升高发生率比较,差异有统计学意义(P<0.05),其中合并高血压、糖尿病的血浆渗透压升高发生率与其他疾病比较,差异均有统计学意义(P<0.05);死亡患者入院血浆渗透压水平与存活患者比较,差异有统计学意义(t=4.795,P<0.05);入院时血浆渗透压升高组预后与正常组比较,差异有统计学意义(u=-4.1613,P=0.000);缺血性脑卒中患者入院血浆渗透压测定平均值与出血性脑卒中患者比较,差异无统计学意义(t=0.0129,P>0.05);丘脑出血患者入院血浆渗透压测定平均值与非丘脑出血患者比较,差异无统计学意义(t=0.0212,P>0.05);逐步Logistic回归分析显示,在校正了其他影响因素的条件下,入院时血浆渗透压升高是影响急性脑卒中患者住院期间死亡的独立危险因素(P=0.042)。结论血浆渗透压的测定对于评价急性脑卒中预后及指导治疗均有重要意义,入院时血浆渗透压水平可作为评价急性脑卒中患者预后的独立指标之一,对其进行动态监测可用以指导临床治疗。

Objective To investigate the association of plasma osmotic pressure and acute stroke.Methods Totally 423 inpatients with acute stroke from January 2011 to October 2011 were enrolled in this study.The plasma osmotic pressure at admission was measured.Multiple factors that are associated with plasma osmotic pressure were analyzed and the influence of plasma osmotic pressure on the prognosis of these patients were investigated.Results The plasma osmotic pressure showed significant differences among the acute stroke patients accompanies with different comorbidities including hypertension and diabetes mellitus（P〈0.05）.It also significantly differed between patients who died during hospitalization and those who survived（t=4.795,P〈0.05）.Compared with the normal group,the plasma osmotic pressure significantly increased in acute stroke group（u=-4.1613,P=0.000）.It was also significantly different between ischemic stroke patients and hemorrhagic stroke patients（t=0.0129,P〉0.05）.Nevertheless,it showed no significant difference between thalamus hemorrhage patients and other cerebral hemorrhage patients（t=0.0212,P〉0.05）.Multivariate logistic regression model suggested that,when other factors were adjusted,the elevated plasma osmotic pressure was an independent risk factor of in-hospital death among acute stroke patients（P=0.042）.Conclusion Plasma osmotic pressure is an independent predictor of the prognosis of the acute stroke patients and therefore can be used to evaluate the prognosis and guide the management.