林芝地区卒中二级预防现状调查与分析

Investigation and Analysis on Secondary Prevention of Stroke in Linzhi District

目的调查和分析林芝地区卒中的二级预防现状。方法选取2017年1月至2018年6月林芝市人民医院住院及心血管疾病筛查患者中200例确诊为脑卒中的患者作为研究对象,详细登记患者的临床资料,制定并实施二级预防措施。随访1年,采用门诊随访、电话随访相结合方式,分析复发情况及其影响因素。结果根据TOAST分型标准,200例脑卒中患者中,LAA型31例(15.50%), CE型14例(7.00%), SAA型65例(32.50%), SOE型7例(3.50%), SUE型83例(41.50%)。随访1年后,43例患者复发,复发率为21.50%。复发组和未复发组行单因素分析,在血压、血糖、血脂代谢、饮食、抗血小板药物执行、心房纤颤、嗜烟酗酒等方面,差异有统计学意义(P<0.05)。行Logistic多因素回归分析显示,血压不达标、饮食不规律、抗血小板药物用药不依从、嗜烟酗酒等均为脑卒中复发的危险因素(P<0.05)。结论林芝地区卒中的二级预防工作不容乐观,疾病1年复发率较高,加强对脑卒中复发因素的分析,是进一步提高二级预防水平乃至诊治水平的关键。

Objective To investigate and analyze the status of secondary prevention of stroke in Linzhi district. Methods 200 patients diagnosed as stroke from January 2017 to December 2018 in Linzhi People’s Hospital were selected as study objects. Clinical data of patients were registered, and secondary prevention measures were formulated and implemented. Patients were followed up for 1 year, and the relapse and its influencing factors were analyzed by means of outpatient follow-up and telephone follow-up. Results According to the TOAST classification criteria, among 200 stroke patients, there were 31 cases of LAA type(15.50%), 14 cases of CE type(7.00%), 65 cases of SAA type(32.50%), 7 cases of SOE type(3.50%), and 83 cases of SUE type(41.50%). After 1 year’s follow-up, 43 patients relapsed, with the relapse rate of 21.50%. Single factor analysis between relapse group and non-relapse group showed statistical differences in blood pressure, blood sugar,lipid metabolism, anti-platelet drug implementation, diet, atrial fibrillation and smoking/alcohol abuse(P<0.05). Logistic multivariate regression analysis showed that substandard blood pressure, irregular diet, noncompliance with anti-platelet drugs, smoking/alcohol abuse were risk factors for stroke relapse(P<0.05). Conclusions Secondary prevention of stroke in Linzhi district is not optimistic, and the relapse rate of stroke is relatively high in one year. Strengthening the analysis of the factors of stroke relapse is the key to further improve the level of secondary prevention and even the levels of diagnosis and treatment.