影响进展性脑梗死临床预后相关因素分析

The analysis of relevant factors influencing the prognosis of progressive cerebral infarction

目的 探讨影响进展性脑梗死临床预后相关因素,为临床治疗及改善患者预后提供依据。方法 163例确诊为进展性脑梗死的患者为观察组,同期收治的355例非进展性脑梗死患者作为对照组,两组患者均有详细临床资料记录,且均在发病后第30天和第90天进行临床随访,对进展性脑梗死的临床预后相关因素进行分析和总结,以住院后最重时的美国国立卫生院卒中量表（NIHSS）分值为因变量进行多元线性回归分析。分别以第30天和第90天时日常生活活动能力（ADL）量表评分和改良Rankin量表（mRS）的分值为因变量进行多元线性回归分析,比较两组ADL、mRS评分。结果 影响观察组患者住院后病情加重的主要因素为完全前循环梗死、冠心病史、呼吸道感染、水电解质紊乱、血白细胞升高。观察组患者第30天和第90天ADL和mRS分别为（45.58±16.53）分、（2.98±1.79）分、（41.22±15.72）分、（2.51±1.49）分,均高于对照组的（36.52±15.85）分、（2.13±1.66）分、（34.37±13.61）分、（1.99±1.28）分（分别t=6.6179,P=0.000;t=5.2788,P=0.000;t=5.0608,P=0.000;t=4.0725,P=0.000）。观察组第30天脑梗死复发率及病死率分别为8.59%、7.98%,明显高于对照组的2.81%、3.38%（χ2=8.423,P=0.004;χ2=5.135,P=0.023）;观察组第90天脑梗死复发和病死率分别为11.04%、11.65%,均明显高于对照组的7.32%、6.67%（χ2=1.938,P=0.159;χ2=3.518,P=0.061）。结论 影响进展性脑梗死病情加重及临床预后的因素较多,早期应积极治疗,尽可能最大程度地改善进展性脑梗死患者的预后。

Objective To explore the relevant factors influencing the prognosis of progressive cerebral infarction,in order to provide basis for clinical trentment and improve the prognosis of patients.Methods Clinical data of 163 patients admitted as progressive cerebral infarction and 355 patients admitted as non-progressive cerebral infarction were retrospectively analyzed.All patients were followed up by interview or telephone at the time of 30 and 90 days,the clinical data were recorded.The relevant factors influencing the prognosis of progressive cerebral infarction were analyzed.Results Multiple linear regression analysis of patients with progressive cerebral infarction showed that total anterior circulation infarcts,respiratory infection,coronary heart disease history,imbalance of water and electrolyte,white blood cell increasing were leading influence risk factors for the higher National Institutes of Health Stroke Scale（NIHSS） in hospitalized patients.Analysis of patients with progressive cerebral infarction showed that total anterior circulation infarcts,lack of physical activity,NIHSS at admitting,the elderly and respiratory infection were leading influence risk factors of the higher Activities of Daily Living（ADL） and modify Rankin Scale（mRS） scores at 30d and 90d of following up.The scores of ADL and mRS at 30d and 90d were significantly higher in progressive cerebral infarction than those of non-progressive cerebral infarction patients（t=6.6179,P=0.000,t=5.2788,P=0.000,t=5.0608,P=0.000,t=4.0725,P=0.000,respectively）.The recurrence of cerebral infarction in progressive cerebral infarction group and death events at 30d were also significantly higher than that of non-progressive cerebral infarction（χ2=8.423,P=0.004 and χ2=5.135,P=0.023,respectively）.But the recurrence of progressive cerebral infarction and death events at 90d,there were no significant differences between progressive cerebral infarction and non-progressive cerebral infarction（χ2=1.938,P=0.159 and χ2=3.518,P=0.061,respectively）.Conclusion The relevant factors influencing the prognosis of progressive cerebral infarction are common effect of various factors.In the treatment of progressive cerebral infarction should be actively considered as much as possible to improve the prognosis of patients.