农村缺血性脑卒中患者脑卒中复发风险自我感知与客观复发风险的一致性及对策分析

Self-perceived and Objective Recurrence Risk of Stroke in Rural Patients with Ischemic Stroke:Consistency Analysis and Countermeasures

背景疾病复发风险自我感知已得到国外众多学者关注,但国内尚缺乏脑卒中复发风险自我感知相关研究。目的分析农村缺血性脑卒中患者脑卒中复发风险自我感知与客观复发风险的一致性及对策。方法采用方便抽样法选择2020年5—8月在安阳市滑县人民医院神经内科住院的农村缺血性脑卒中患者295例作为调查对象,采用自设问卷收集相关信息,主要包括人口学特征、复发担忧程度、残障程度、脑卒中客观复发风险、脑卒中复发风险自我感知等。结果295例患者中Essen卒中风险评估量表评估结果为低风险者144例(48.8%),中等风险者151例(51.2%),高等风险者0例;脑卒中复发风险自我感知为低危者152例(51.5%),中危者47例(15.9%),高危者45例(15.3%),不清楚者51例(17.3%);一致性分析结果为低估者69例(23.4%),准确者115例(39.0%),高估者60例(20.3%),无法判断者51例(17.3%)。不同Essen卒中风险评估量表评估结果患者脑卒中复发风险自我感知、一致性分析结果比较,差异有统计学意义(P<0.05)。Spearman秩相关分析结果显示,农村缺血性脑卒中患者Essen卒中风险评估量表评估结果与一致性分析结果呈负相关(rs=-0.498,P<0.001)。多因素Logistic回归分析结果显示:性别、体质指数(BMI)、职业、合并症数量、复发担忧程度是农村缺血性脑卒中患者一致性分析结果为低估的影响因素,而BMI、职业、主要照顾者、复发担忧程度是农村缺血性脑卒中患者一致性分析结果为准确的影响因素(P<0.05)。结论农村缺血性脑卒中患者脑卒中复发风险自我感知与客观复发风险的一致性分析结果准确率较低,且不同脑卒中客观复发风险患者脑卒中复发风险自我感知、一致性分析结果存在差异;性别、BMI、职业、合并症数量、家庭人均月收入、复发担忧程度是农村缺血性脑卒中患者一致性分析结果为低估的影响因素,而BMI、职业、主要照顾者、家庭人均月收入、复发担心程度是农村缺血性脑卒中患者一致性分析结果为准确的影响因素。

Background Although the self-perceived recurrence risk of diseases has received much attention abroad,there is lack of studies about self-perceived recurrence risk of stroke in China.Objective To explore the consistency between self-perceived and objective recurrence risk of stroke in rural patients with ischemic stroke and put forward countermeasures.Methods This study was carried out from May to August 2020.Participants were 295 rural neurology inpatients with ischemic stroke selected from People's Hospital of Hua County,Anyang.A survey using a self-developed questionnaire was conducted to collect related information,mainly including demographic characteristics,fear of recurrence,disability degree,objective and self-perceived recurrence risk of stroke.Results Of the participants,the number of patients who were evaluated with low,medium and high recurrence risk of stroke by Essen Stroke Risk Score(ESRS)was 144(48.8%),151(51.2%),and 0,respectively.And the number of patients who subjectively evaluated themselves with self-perceived low,medium and high recurrence risk of stroke was 152(51.5%),47(15.9%),and 45(15.3%),respectively;other 51 cases(17.3%)could not evaluate their risk clearly.Compared to the evaluation by the ESRS,69 cases(23.4%)underestimated their risk,115(39.0%)accurately assessed their risk,60(20.3%)overestimated their risk,51(17.3%)could not perceive their risk distinctly.The self-perceived recurrence risk of stroke and consistency analysis result were significantly different from those evaluated by the ESRS(P<0.05).Spearman rank correlation analysis demonstrated that the assessment result of the ESRS was negatively correlated with the consistency analysis result(rs=-0.498,P<0.001).Multivariate Logistic regression analysis results showed that,gender,BMI,occupation,number of combined disease and fear of recurrence were influencing factors of underestimating the recurrence risk of stroke in the consistency analysis in rural patients with ischemic stroke,while BMI,occupation,main caregiver and fear of recurrence were influencing factors of accurately assessing the recurrence risk of stroke(P<0.05).Conclusion The consistency between self-perceived and objective recurrence risk of stroke was relatively low in rural patients with ischemic stroke.And there were significant differences of the self-perceived recurrence risk of stroke and consistency analysis result in patients with different objective recurrence risk of stroke.Gender,BMI,occupation,number of combined disease,monthly household income per capita and fear of recurrence were associated with underestimating the recurrence risk of stroke in the consistency analysis in rural patients with ischemic stroke,while BMI,occupation,main caregiver,monthly household income per capita and fear of recurrence were associated with accurately estimating.