脑梗死患者再发脑梗死的多因素分析及预防措施

Multivariate analysis and preventive measures of recurrent cerebral infarction in patients with cerebral infarction

目的分析脑梗死患者再发脑梗死的相关因素并总结相应的预防措施。方法回顾性分析2019年2月至2020年8月本院收治的60例初发脑梗死患者(初发组)和60例再发脑梗死患者(再发组)的临床资料。比较两组并发疾病、吸烟习惯、预防性治疗情况、血脂水平及血液流变学指标,采用多因素Logistic回归分析影响其再发脑梗死发生的危险因素。结果再发组合并高血压伴、冠心病伴、糖尿病发生率及吸烟率均明显高于初发组,预防性治疗占比明显低于初发组,差异有统计学意义(P<0.05)。两组高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)水平比较差异无统计学意义;再发组总胆固醇(TC)水平高于初发组,差异有统计学意义(P<0.05)。再发组全血高切黏度、全血低切黏度、血浆黏度、全血还原黏度、红细胞积压均明显高于初发组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,高血压、糖尿病、吸烟、高胆固醇及全血高切黏度增加是导致脑梗死患者再发脑梗死的独立危险因素,预防性治疗是脑梗死患者再发脑梗死的保护因素(P<0.05)。结论脑梗死患者发生再发脑梗死的独立危险因素为高血压、糖尿病、吸烟、高胆固醇及全血高切黏度增加,临床需根据其危险因素做好预防性治疗工作,同时,应加强患者健康指导,以尽量降低患者再发脑梗死风险。

Objective To analyze the related factors of recurrent cerebral infarction in patients with cerebral infarction and summarize the corresponding preventive measures.Methods The clinical data of 60 patients with primary cerebral infarction(primary group)and 60 patients with recurrent cerebral infarction(recurrent group)admitted to our hospital from February 2019 to August 2020 were retrospectively analyzed.The concomitant diseases,smoking habits,preventive treatment,blood lipid levels and hemorheology indexes were compared between the two groups,multivariate Logistic regression analysis was used to analyze the risk factors affecting the occurrence of recurrent cerebral infarction.Results The rates of hypertension,coronary heart disease,diabetes and smoking in the recurrent group were significantly higher than those in the primary group,and the proportion of preventive treatment was significantly lower than that in the primary group,and the differences were statistically significant(P<0.05).There were no significant differences in high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)and triglyceride(TG)levels between the two groups;the total cholesterol(TC)level in the recurrent group was higher than that in the primary group,and the difference was statistically significant(P<0.05).The whole blood high shear viscosity,whole blood low shear viscosity,plasma viscosity,whole blood reduced viscosity and hematocrit in the recurrent group were significantly higher than those in the primary group,and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed that hypertension,diabetes,smoking,high cholesterol and high tangential viscosity of whole blood were independent risk factors for recurrent cerebral infarction in patients with cerebral infarction,and preventive treatment was protective factor for recurrent cerebral infarction in patients with cerebral infarction(P<0.05).Conclusion The independent risk factors of recurrent cerebral infarction in patients with cerebral infarction are hypertension,diabetes,smoking,high cholesterol and high tangential viscosity of whole blood,preventive treatment should be done according to the risk factors,meanwhile,health guidance should be strengthened to reduce the risk of recurrent cerebral infarction as far as possible.