缺血性脑卒中急性期治疗结局影响因素的回顾分析

Retrospective study on treatment outcomes and influential factors of ischemic stroke in acute phase

[目的]探讨缺血性脑卒中急性期治疗结果与可能的影响因素的关系。[方法]回顾性收集上海市普陀区中心医院神经内科2012年1月—8月发病72 h内就诊的急性缺血性脑卒中,且NIHSS评分≥4分的109例患者资料。治疗结局按照急性期(2周)神经功能缺损评分(NIHSS)、治疗后改善情况分为显效组(>30%)、改善组(10%～30%)、无改善组(<10%)、加重组(<0分)和死亡组5组,采用卡方检验和Logistic回归分析研究可能的影响因素与治疗结果的关系。[结果]缺血性脑卒中急性期治疗结果与性别、吸烟史、OCSP分型、是否合并高血压病、糖尿病、冠心病、高脂血症、是否为复发无显著相关性(P>0.05),而与年龄、是否初始NIHSS评分>10分、是否合并发热及发病72 h内有无使用降压药物显著相关(P=0.043,0.023,0.003,0.002),其中是否使用钙离子拮抗剂CCB降压与疗效差异显著相关(P=0.001),而是否使用ACEI或ARB降压与疗效差异无显著相关性(P=0.169)。Logistic分析结果进一步证实,使用降压药物是降低缺血性卒中急性期治疗效果的主要危险因素(OR=4.406,95%CI:1.84-10.53)。[结论]缺血性脑卒中NIHSS>10分预示急性期治疗结果不佳,且发病72 h内应尽量避免使用各种降压药物,尤其是钙离子拮抗剂。

[ Objective ] To explore the relation between treatment outcomes in acute phase and possible influential factors of ischemic stroke. [ Methods ] We studied 109 consecutive in - hospital patients admitted by neurology department within the first 24 hours of onset from January2012 to August 2012. The treatment outcomes after two weeks were divided into five groups according to the National Institutes of Health Stroke Scale（NIHSS）. The influential factors were analyzed by monovariate and bivariate regression analysis. [ Results ] Monovariate and bivariate regression analysis showed that unfavourable outcomes were associated with high NIHSS （ 〉 10 ） and early use of antihypertensive drugs （ OR = 4. 406,95 % CI： 1.84 - 10.53 ）. And its correlation with the use of calcium antagonists （ CCB } was more significant than angiotensin converting enzyme inhibitors（ACEI） and/or angiotensin receptor blocker（ARB） （P = 0.001,0. 169）. [ Conclusion] NIHSS 〉 10 predicts poor outcomes of treatment in the acute phase of ischemic stroke and we should avoid using antihypertensive drugs, especially CCB, within the first 72 hours of onset.