中老年急性缺血性脑卒中患者共病状态与卒中后功能恢复的相关性研究

Correlation Analysis between Comorbidity and Functional Recovery after Stroke in Middle-aged and Elderly Patients with Acute Ischemic Stroke

背景中老年急性缺血性脑卒中患者同时患有多种慢性病,并且这种共病状态对患者的预后功能恢复产生较大影响。目的探讨中老年急性缺血性脑卒中患者共病状态与卒中后出院美国国立卫生研究院卒中量表(NIHSS)评分及出院3个月后改良Rankin量表(mRS)评分的关系。方法收集2016年1月-2018年6月在温江区人民医院神经内科住院的≥45岁的急性缺血性脑卒中患者293例,记录其临床信息、疾病累积评分量表(CIRS)评分、共病指数、严重指数、入院及出院的NIHSS评分(以出院NIHSS评分为0~2分或较入院时减少≥4分为出院时好转)、出院3个月后m RS评分(以出院3个月后m RS评分≤2分为预后良好)等资料。分析患者共病状态与出院好转与否及出院3个月随访卒中后功能恢复的关系。结果最终纳入的264例患者的CIRS平均得分为(9.58±5.04)分、严重指数为(0.67±0.36)、共病指数为(3.30±1.83)、入院NIHSS得分为6(4,11)分、出院NIHSS得分为3(1,8)分。不同CIRS评分分层患者的年龄、严重指数、共病指数、入院NIHSS评分、出院NIHSS评分、住院天数、出院3个月后mRS评分比较,差异有统计学意义(P<0.05);出院时是否好转患者的CIRS评分分层比较,差异有统计学意义(P<0.05);不同预后情况患者的CIRS评分分层、年龄、严重指数、共病指数、出院NIHSS评分、住院天数比较,差异有统计学意义(P<0.05)。出院NIHSS评分、入院NIHSS评分、严重指数、CIRS评分、心房颤动、共病指数、年龄、住院天数与患者出院3个月后m RS评分呈正相关;高血压与患者出院3个月后m RS评分呈负相关(P<0.05)。结论中老年急性缺血性脑卒中患者共病状态与卒中后出院NIHSS评分、3个月后m RS评分有密切的关系。CIRS评分较低、年龄较小、共病指数和严重指数低的患者预后良好。

Background A large number of clinical diagnosis results show that middle-aged and elderly patients with acute ischemic stroke suffer from a variety of chronic diseases at the same time,and this co-disease state has a great impact on the recovery of prognostic function of patients.Objective To investigate the relationship between comorbidity and the National Institutes of Health Stroke Scale(NIHSS) scores and modified Rankin Scale(m RS) scores after three months in middle-aged and elderly patients with acute ischemic stroke.Methods Information of 293 patients with acute ischemic stroke aged 45 and over who were hospitalized in the Department of Neurology in Wenjiang District People’s Hospital from January 2016 to June 2018 were prospectively collected,including their clinical information,Cumulative Illness Rating Scale(CIRS) scores,comorbidity index,severity index,NIHSS scores at admission and discharge(the discharge NIHSS score was 0 to 2 points or decreased ≥ 4 points compared with the admission score, and the discharge score was improved),and m RS scores after three months(mRS score ≤ 2 after three months discharge was considered as a good prognosis).The relationship between comorbidity and functional recovery at follow-up after three months of discharge was analyzed.Results The average CIRS score was(9.58±5.04);the severity index was(0.67±0.36);the comorbidity index was(3.30±1.83);and the scores of admission NIHSS and discharge NIHSS were 6(4,11) and 3(1,8) respectively.The age,severity index,comorbidity index,admission NIHSS score,discharge NIHSS score,length of stay,and m RS score of the stratified patients with different CIRS scores showed statistically significant differences(P<0.05).Stratified comparison of CIRS scores of patients with different discharge improvement conditions showed statistically significant difference(P<0.05).CIRS score stratification,age,severity index,comorbidity index,discharge NIHSS score and length of hospital stay of patients with different prognosis showed statistically significant differences(P<0.05).NIHSS scores at discharge and admission,severity index,the CIRS scores,atrial fibrillation,comorbidity index,age and hospitalization time were positively correlated with m RS scores after thee months.Hypertension was negatively correlated with m RS scores after thee months(P<0.05).Conclusion There is a significant relationship between comorbidity and NIHSS scores at discharge and m RS scores after three months in middle-aged and elderly patients with acute ischemic stroke.The patients who are younger with lower CIRS scores,comorbidity index and severity index have a good prognosis.