脑梗死患者6个月死亡危险因素分析:南京市第一医院卒中登记

Risk factors of death in patients with cerebral infarction at 6 months: study of Nanjing First Hospital stroke registry

目的探讨脑梗死的临床特征及其6个月死亡预测因素,为早期干预提供依据。方法根据南京市第一医院卒中登记,前瞻性记录2004~2008年间连续收治的脑梗死患者,详细记录患者的临床资料。于发病90 d随访患者本人或家属,记录所有临床事件及其发生时间。采用mRS量表对患者预后进行评分。使用Logistic回归模型分析各影响因素与卒中6个月死亡的关系。结果符合纳入标准脑梗死患者共计1833例,发病6个月时死亡283例,死亡率15.4%。多因素分析显示：年龄（OR=1.028,95%CI：1.014~1.043）、心房纤颤（OR=2.000,95%CI：1.272~3.145）、脑卒中（OR=1.524,95%CI：1.000~2.321）、中重度神经功能缺损（OR=5.933,95%CI：4.126~8.530）、肾功能损伤（OR=1.987,95%CI：1.150~3.435）、肺部感染（OR=3.869,95%CI：2.727~5.489）、消化道出血（OR=3.859,95%CI：1.86~8.002）是脑梗死6个月死亡的独立危险因素（均P≤0.05）。结论年龄、心房纤颤、脑卒中、中重度神经功能缺损、肾功能损伤、肺部感染、消化道出血是脑梗死6个月死亡的独立危险因素。

Objective To study the risk factors of death in patients with cerebral infarction at 6 month and to provide evidence for early intervention. Methods According to Nanjing First Hospital stroke registry,patients with cerebral infarction was prospectively registered from 2004 to 2008. Clinical characteristics of patients were recorded in detail. The follow-up was conducted at 90 d by interviewing patients or their relatives after hospital discharge. Clinical events and time of occurrence were recorded; mRS was used to evaluate the outcome after cerebral infarction. Logistic regression model was used to analysis the relationship between risk factors and death at 6 months. Results A total of1833 patients with cerebral infarction were included in the study. And 283 patients were dead at 6 months,the death rate was 15. 4%. Multivariate logistic regression analysis indicated that age（ OR = 1. 028,95% CI： 1. 014- 1. 043）,atrial fibrillation（ OR = 2. 000,95% CI： 1. 272- 3. 145）,previous stroke（ OR = 1. 524,95% CI： 1. 000- 2. 321）,moderate to severe neurologic deficits（ OR = 5. 933,95% CI： 4. 126- 8. 530）,renal function injury（ OR = 1. 987,95% CI： 1. 150- 3. 435）,pneumonia（ OR = 3. 869,95% CI： 2. 727- 5. 489） and gastrointestinal bleeding（ OR =0. 464,95% CI： 0. 217- 0. 995） were the independent risk factors of death for cerebral infarction at 6 months（ all P≤0. 05）. Conclusion Age,atrial fibrillation,previous stroke,moderate to severe neurologic deficit,renal function injury,pneumonia and gastrointestinal bleeding are the independent risk factors of death at 6 months after cerebral infarction.