缺血性脑卒中患者并发胃肠功能紊乱的临床分析

Clinical analysis of cerebral apoplexy patients complicated with gastrointestinal dysfunction

目的总结缺血性脑卒中患者并发胃肠功能紊乱的临床情况及相关因素。方法回顾性分析2009年1月至2014年5月收治的200例脑卒中患者的临床资料,根据患者入院1周后是否并发胃肠功能紊乱分为观察组(胃肠功能紊乱,120例)和对照组(未发生胃肠功能紊乱,80例),对两组患者的相关临床指标进行统计分析。结果在基底节、丘脑、脑叶、小脑、脑干五个部位中,仅基底节、脑叶部位梗死率在两组间差异显著(P<0.05)。脑卒中昏迷组的呕吐发生率(55.9%)、便秘发生率(30.4%)均显著的高于非昏迷组且差异显著(P<0.05),其他胃肠道症状在两组间差异不显著(P>0.05)。入院时观察组和对照组的患者的血清白蛋白(ALB)、血清前白蛋白(PA)、视黄醇结合蛋白(RBP)比较差异均不显著(P>0.05),但观察组患者的NIHSS评分(14.3±1.2)分、血糖(11.7±2.2)mmol/L均显著的高于对照组患者(P<0.05)。入院2周后观察组患者的ALB、PA、RBP值均显著低于对照组、NIHSS评分分、血糖值均显著的高于对照组且差异均显著(P<0.05)。结论缺血性脑卒中患者并发胃肠道功能紊乱可能和神经功能缺损严重程度、营养状况、梗死部位、血糖水平有一定的关系。

Objective To sum up the clinical situation and related factors of gastrointestinal dysfunction in patients with ischemic stroke. Methods Retrospective analysis of the clinical data of 200 patients with stroke in our hospital from January 2009 to May 2014 was analyzed. The patients were divided into observa-tion group （with gastrointestinal dysfunction, 120 cases） and control group （without the occurrence of gastroin-testinal dysfunction, 80 cases） according to whether the gastrointestinal dysfunction occurred 1 weeks after ad-mission. Results In the five parts of the basal ganglia, thalamus, Lobe of brain, cerebellum and brainstem, on-ly basal ganglia and lobe of the brain infarction rate had significant difference between the two groups （P〈0.05）. The incidence of vomiting was 55.9%in stroke coma group. The incidence of constipation （30.39%） was significantly higher in coma group than that in non coma group （P〈0.05）. Other gastrointestinal symptoms were not significantly different between the two groups （P〉0.05）. On admission, serum albumin, serum preal-bumin, and retinol binding protein were no significant difference between the observation group and the control group （P〉0.05）, but NIHSS score （14.3 ± 1.2） and blood glucose （11.7 ± 2.2）mmol/L in observation group patients were significantly higher than those in the control group patients （P〈0.05）. Two weeks after admis-sion, serum prealbumin,and retinol binding protein values in observation group were significantly lower than those in control group,while NIHSS score, blood glucose values were significantly higher than the control group （P〈0.05）. Conclusion The functional disorder of gastrointestinal tract in patients with ischemic stroke may have a certain relationship with the severity of neurological deficits, nutritional status, infarct location and blood glucose levels.