急性缺血性卒中患者早期神经功能恶化的危险因素研究

Risk Factors of Early Neurological Deterioration in Patients with Acute Ischemic Stroke

目的探讨急性缺血性卒中患者早期神经功能恶化的危险因素。方法选取2012年7月—2014年6月安阳市人民医院收治的急性缺血性卒中患者260例,根据患者是否发生早期神经功能恶化分为发生早期神经功能恶化77例(进展组)和未发生早期神经功能恶化183例(非进展组)。回顾性分析患者的临床资料,记录患者年龄、性别、合并疾病(高血压、高脂血症、糖尿病、缺血性心脏病)、既往卒中或短暂性脑缺血发作(TIA)史、吸烟情况、饮酒情况、发热情况、入院时收缩压、入院时舒张压、血脂指标、空腹血糖、纤维蛋白原、基线美国国立卫生研究院卒中量表(NIHSS)评分、梗死体积、TOAST病因学分型及治疗用药情况,采用多因素Logistic回归分析对急性缺血性卒中患者早期神经功能恶化的危险因素进行分析。结果两组患者年龄、性别、高血压发生率、吸烟率、饮酒率、入院时舒张压、血脂指标、TOAST病因学分型及治疗用药比较,差异均无统计学意义(P>0.05);进展组患者高脂血症、糖尿病、缺血性心脏病、发热发生率和既往卒中或TIA史阳性率、基线NIHSS评分、空腹血糖及纤维蛋白原水平高于非进展组,梗死体积大于非进展组,入院时收缩压低于非进展组(P<0.05)。多因素Logistic回归分析结果显示,空腹血糖偏高〔OR=1.31,95%CI(1.02,1.74)〕、既往有卒中或TIA史〔OR=1.14,95%CI(1.01,1.35)〕、基线NIHSS评分偏高〔OR=1.08,95%CI(1.04,1.13)〕、发热〔OR=1.01,95%CI(1.00,1.47)〕、纤维蛋白原偏高〔OR=1.04,95%CI(1.00,1.23)〕、入院时收缩压偏低〔OR=1.03,95%CI(1.01,1.13)〕是急性缺血性卒中患者早期神经功能恶化的独立危险因素(P<0.05)。结论空腹血糖偏高、既往卒中或TIA史、发热、基线NIHSS评分偏高、纤维蛋白原偏高、入院时收缩压偏低是急性缺血性卒中患者早期神经功能恶化的危险因素,应加强治疗和护理,以降低早期神经功能恶化发生率。

Objective To investigate the risk factors of early neurological deterioration in patients with acute ischemic stroke. Methods A total of 260 patients with acute ischemic stroke were selected in the People＇s Hospital of Anyang from July2012 to June 2014,and they were divided into A（ with early neurological deterioration,n = 77） and B group（ without early neurological deterioration, n = 183） according to the incidence of early neurological deterioration. Clinical data was retrospectively analyzed, including age, gender, coexistent diseases（ including hypertension, hyperlipidaemia, diabetes mellitus,ischemic heart disease）, stroke or TIA history, smoking rate, drinking rate, incidence of fever, systolic blood pressure at admission, diastolic blood pressure at admission, blood lipid parameters, FPG, FIB, baseline NIHSS score,infarction volume,TOAST etiological types and therapeutic medications, multivariate Logistic regression analysis was used to analyze the risk factors of early neurological deterioration in patients with acute ischemic stroke. Results No statistically significant differences of age, gender, incidence of hypertension, smoking rate, drinking rate, diastolic blood pressure at admission,blood lipid parameters,TOAST etiological types or therapeutic medications was found between the two groups（ P〈0. 05）; the incidence of hyperlipidaemia,diabetes mellitus, ischemic heart disease and fever, positive rate of stroke or TIA history,baseline NIHSS score,FPG and FIB of A group were statistically significantly higher than those of B group,infarction volume of A group was statistically significantly larger than that of B group,while systolic blood pressure at admission of A group was statistically significantly lower than that of B group（ P〈0. 05）. Multivariate Logistic regression analysis showed that,increased FPG 〔OR = 1. 31,95% CI（ 1. 02,1. 74） 〕,positive stroke or TIA history 〔OR = 1. 14,95% CI（ 1. 01,1. 35） 〕,increased baseline NIHSS score 〔OR = 1. 08,95% CI（ 1. 04,1. 13） 〕, fever 〔OR = 1. 01,95% CI（ 1. 00,1. 47） 〕,increased FIB 〔OR = 1. 04,95% CI（ 1. 00,1. 23） 〕,decreased systolic blood pressure at admission 〔OR = 1. 03,95% CI（ 1. 01,1. 13） 〕 were risk factors of early neurological deterioration in patients with acute ischemic stroke（ P〈0. 05）.Conclusion Increased FPG,positivestroke or TIA history,increased baseline NIHSS score,fever,increased FIB,decreased systolic blood pressure at admission are risk factors of early neurological deterioration in patients with acute ischemic stroke,patients with above factors should be pay more attentions to,in order to reduce the incidence of early neurological deterioration.