初发急性脑卒中患者出院步行能力预测研究

Prediction of walking function at discharge in patients with the first acute stroke.

目的 根据发病及入院时资料预测初发急性脑卒中患者出院时的步行能力。方法 回顾性分析 5 2 4例初发急性脑卒中患者 ,42例住院期间死亡 ,482例生存者中 ,173例入院时可以行走 ,3 0 9例不能行走。根据 3 0 9例患者出院时能否步行 ,将其分为步行组 (n =164例 )和非步行组 (n =14 5 )。收集的资料包括病史、入院时体格检查、第一次生化和心电图检查。对收集的资料采用单因素方差分析和多元回归分析。结果 单因素分析发现 ,2组在年龄、中风类型、糖尿病病史、入院时的神志、肢体瘫痪、尿失禁、肺部感染、血糖及尿素氮水平之间的差异有非常显著性和显著性意义 (P =0 .0 0 0 5～ 0 .0 2 0 0 )。多元回归分析发现 ,年龄、脑卒中类型、糖尿病史、入院时尿失禁及明显的肢体瘫痪是预测出院时能否行走的可靠因子 (P =0 .0 0 0 5～0 .0 41)。结论 初发脑卒中患者发病及入院时的资料可以用来预测患者出院时的步行能力 。

Objective To predict walking function at discharge in the Chinese patients with first acute stroke. Methods A total of 524 Chinese patients with first acute stroke were analyzed retrospectively. Among them, 42 died during hospitalization, 309 of the 482 survivors were unable to walk on admission. Patients were divided into two groups according to their outcomes of walking function at discharge: able to walk ( n =164) and unable to walk ( n =145). Data were collected regarding the patients' medical history, physical examination on admission and results of first laboratory tests as well as electrocardiogram. Oneway ANOVA was used to compare the difference between the two groups and multivariance regression applied to analyze data. Results Statistically significant differences between the 2 groups were found in terms of age, type of stroke, history of diabetes (DM), consciousness, leg paralysis, incontinence, pulmonary infection, level of blood sugar and urinary nitrogen on admission ( P =0.0005 0.0200 ). Multivariance regression analysis revealed that age, type of stroke, history of DM, incontinence and moderate to severe paralysis of the affected lower extremity strongly predicted the walking function of the patients at discharge ( P = 0.0005 0.041). Conclusion Information of patients with the first acute stroke on admission can be taken as reliable factors to predict the walking function at discharge. The results of the study can be also used as inclusion criteria of the patients for rehabilitation.