老年急性轻型脑卒中患者中陈旧性腔隙性脑梗死的流行病学调查

Epidemiological investigation of old lacunar infarction in elderly patients with acute mild cerebral stroke

目的对上海崇明地区多家医院收治的老年急性轻型脑卒中患者中陈旧性腔隙性脑梗死情况进行流行病学调查,为该地区老年患者心脑血管健康管理策略制定提供参考依据。方法明确调查时间范围、对象、内容、诊断标准及方法、数据收集整理等内容,并将每项工作落实到明确的人员负责。根据调查方案实施调查。按照是否有陈旧性腔隙性脑梗死分为观察组(102例)和对照组(1177例),收集整理2组患者的人口学资料、脑卒中病情相关资料病比较,收集整理有陈旧性腔隙性脑梗死患者陈旧性腔隙性脑梗死患者的临床特点。入组患者随访1年,比较2组患者预后情况,提出针对性的脑血管健康管理建议。结果老年急性轻型脑卒中患者中陈旧性腔隙性脑梗死率及确诊途径:共计纳入7家医院中符合条件的老年急性轻型脑卒中患者1279例,其中共检出陈旧性腔隙性脑梗死患者302例,检出率为23.61%,其中因临床症状就诊598例,健康体检681例。老年急性轻型脑卒中患者中年龄≥75岁、既往有吸烟史、饮酒史、脑力劳动者、高血压、脑卒中部位以椎动脉闭塞为主、神经功能缺损评分10~15分、大动脉粥样硬化型者、既往有脑血管病史者检出有陈旧性腔隙性脑梗死的患者比率高于未检出陈旧性腔隙性脑梗死患者(P<0.05)。老年急性轻型脑卒中患者并陈旧性腔隙性脑梗死临床特点:有陈旧性腔隙性脑梗死的患者梗死部位以壳核、尾状核、内囊、丘脑及脑桥为主,均呈多发性,病灶残留小囊腔直径在0.23~1.36 mm。观察组患者随访1年内脑卒中急性发作次数、临床症状加重而住院治疗率明显高于对照组患者(P<0.05)。结论老年急性轻型脑卒中患者中有陈旧性腔隙性脑梗死的比例较高,老年急性轻型脑卒中患者的人口学指标与陈旧性腔隙性脑梗死有关,应加大高龄、有烟酒史、活动少的人群的健康教育力度并增加行MRA检查频次,尽早发现腔隙性脑梗死,采取措施避免其进一步发展为脑卒中,提高此类人群的脑血管健康水平。

Objective To investigate the epidemiological situation of old lacunar infarction in elderly patients with acute mild cerebral stroke in the hospitals in Chongming district of Shanghai,so as to provide reference for the formulation of cardiovascular and cerebrovascular health management strategies for elderly patients in this area.Methods The time range,objects,contents,diagnostic criteria and methods,data collection and collation of the investigation were clearly defined,and each work was carried out by a clear person in charge.The investigation was carried out according to the investigation plan.According to whether there was old lacunar infarction or not,the patients were divided into observation group(n=102)and control group(n=1,177).The demographic data,stroke-related data were analyzed and compared between the two groups,and the clinical characteristics and the prognosis of the patients after 1-year follow up were observed and compared between the two groups,and the corresponding suggestions for cerebrovascular health management were put forward.Results According to the old lacunar infarction rate and its diagnostic approach in elderly patients with acute mild stroke,a total of 1,279 elderly patients with acute mild cerebral stroke in 7 hospitals in the area were enrolled in the investigation,of whom,a total of 302 patients with old lacunar infarction were detected,with the detection rate being 23.61%,among them,598 cases were treated for clinical symptoms and 681 cases were examined for health examination.Among the elderly patients with acute mild cerebral stroke,the incidence rates of old lacunar infarction in the patients with age being≥75 years,with smoking history,drinking history,mental workers,hypertension,stroke sites mainly with vertebral artery occlusion,neurological deficit score of 10~15,atherosclerosis type of great artery,and previous history of cerebrovascular disease were significantly higher than those of deadpatients without old lacunar infarction(P<0.05).Inaddition the clinical characteristics of elderly patientswith acute mild cerebral stroke complicated by oldlacunar infarction were that infarction sites of patientswith old lacunar infarction were mainly putamen,caudate nucleus,internal capsule,thalamus and pons,all of which were multiple,and the diameter ofresidual capsule cavity was within 0.23~1.36 mm.Furthermore the frequency of acute stroke attack and the hospitalization rate because of aggravation of clinical symptoms during 1-year follow up in observation group were significantly higher than those in control group(P<0.05).Conclusion The proportion of old lacunar infarction is higher in elderly patients with acute mild cerebral stroke.The demographic indxes in elderly patients with acute mild cerebral stroke are related to the incidence of old lacunar infarction.Health education should be strengthened among the elderly.It is necessary to discover lacunar infarction as soon as possible,and to take measures to avoid its further development.