脑梗死患者早期神经功能恶化的影响因素分析

Influencing Factors of Early Neurological Deterioration in Patients with Cerebral Infarction

【目的】探讨脑梗死患者发生早期神经功能恶化的影响因素。【方法】选取2013年1月至2016年1月于本院接受治疗的脑梗死患者108例，按患者是否惠有早期神经功能恶化，分为恶化组（n=38）与非恶化组（”=70），比较两组患者一般资料、既往史、临床体征、实验室检查结果的差异，探讨脑梗死患者发生早期神经功能恶化的影响因素。【结果】恶化组高血压、糖尿病、短暂性脑缺血发作或卒中、高脂血症、心房颤动病史比例高于非恶化组（P〈0．05）；恶化组较非恶化组体温高、神经功能缺损得分高，收缩压及舒张压低（P〈0．05）；恶化组I）I二聚体、白细胞水平，凝血酶原时间高于非恶化组，C反应蛋白水平低于非恶化组（P〈0．05）。多因素Logistic回归分析显示，高神经功能缺损评分（OR=1．993），高体温（OR=3．012），低收缩压（OR=2．942），低舒张压（OR=1．838），有高血压（OR=3．522）、糖尿病（OR=1．050）、短暂性脑缺血发作或卒中（OR=1．442）、心房颤动（OR=3．522）病史是患者发生早期神经功能恶化的独立危险因素（P〈0．05）。【结论】神经功能缺损评分过高，体温过高，收缩压及舒张压过低，有高血压、糖尿病、短暂性脑缺血发作或卒中、心房颤动病史是脑梗死患者发生早期神经功能恶化的危险因素，临床应加以重视。

【Objective】To explore the influencing factors of early neurological deterioration in patients with cerebral infarction.【Methods】A total of 108 patients with cerebral infarction treated in our hospital were selected from January 2013 to January 2016. According to whether or not the patient was suffering from early neurological deterioration, patients were divided into the deterioration group （n=38） and the non-deterioration group （n=70）. The differences of baseline data, past history, clinical signs and laboratory results were observed and compared between the two groups, and by multiple factor analysis, the significant factors that affected the early neurological deterioration were observed.【Results】The proportion of hypertension, diabetes, TIA or stroke, hyperlipidemia, and atrial fibrillation history in the deterioration group was higher than that in the non-deterioration group（P〈0.05）. Compared to the non-deterioration group, patients in the deterioration group had higher body temperature, higher scores of nerve function defect, lower systolic and diastolic blood pressure（P〈0.05）, higher level of D-dimer and leukocyte, longer prothrombin time and lower level of C reactive protein（P〈0.05）. Multivariate logistic regression analysis showed that parameters high score of nerve function defect （OR=1.993）, high body temperature （OR=3.012）, lower systolic blood pressure （OR=2.942）, low diastolic blood pressure （OR=1.838）, hypertension （OR=3.522）, diabetes mellitus （OR=1.050）, transient ischemic attack （TIA） or stroke （OR=1.442）, and atrial fibrillation （OR=3.522）] were significant independent risk factors that occurred in the early neurological deterioration（P〈0.05）.【Conclusion】High score of neural function defect, fever, lower systolic and diastolic pressure, hypertension, diabetes, stroke, TIA and atrial fibrillation history are high-risk factors for early neurological deterioration occurred in patients with cerebral infarction. Therefore, clinical attention should be paid to those influencing factors for prevention.