暂未开展介入治疗的区县级医院大动脉粥样硬化缺血性脑卒中的诊疗现状分析

Analysis of Diagnosis and Treatment Status of Atherosclerotic Ischemic Stroke in District and County Hospitals without Interventional Therapy

目的:分析暂未开展介入治疗的区县级大动脉粥样硬化性缺血性脑卒中患者的诊疗现状。方法:回顾日照市岚山区人民医院2021、2022年诊治的大动脉粥样硬化性脑梗死病例。收集患者的临床资料:性别、个人史及慢性病史(高血压、糖尿病、冠心病、脑梗死、高脂血症、吸烟史)、入院NIHSS评分、责任血管、治疗方式(单纯药物、转外院介入手术)、复发情况、随访mRS评分等。并对患者卒中复发的危险因素进行相关性分析。结果:共收集120例大动脉粥样硬化型脑梗死患者,年龄71.42 ± 10.77岁,其中合并高血压病患者96例,占比80%;合并糖尿病、冠心病、脑梗死、高脂血症、吸烟史等,分别为37人(30.83%)、46人(38.33%)、27人(22.5%)、32人(26.67%)、43人(35.83%)。占比30.83%、38.33%、22.5%、26.67%、35.83%。临床随访期间,20%发生缺血性卒中复发。卒中复发的相关因素统计结果显示,性别、高血压、糖尿病、冠心病、脑梗死、高脂血症、吸烟史、NIHSS评分、治疗方式等均与复发与否无统计学相关性差异。而脑梗死责任血管与卒中复发的相关性,具有统计学差异(X2 = 13.009, P = 0.025)。结论:在暂未开展介入治疗的区县级医院,大动脉粥样硬化缺血性脑卒中目前以药物治疗为主,有较高的复发率。卒中的复发与粥样硬化狭窄责任血管的部位具有相关性。

Objective: To analyze the current situation of diagnosis and treatment of large artery atheroscle-rotic ischemic stroke patients who have not yet carried out interventional therapy at district and county level. Methods: The cases of large artery atherosclerotic cerebral infarction diagnosed and treated in 2021 and 2022 in Lanshan District People’s Hospital of Rizhao City were reviewed. Clin-ical data of patients were collected: gender, personal history and chronic disease history (hyper-tension, diabetes, coronary heart disease, cerebral infarction, hyperlipidemia, smoking history), admission NIHSS score, responsible blood vessel, treatment mode (drug only, transfer to other hospital for interventional surgery), recurrence, follow-up mRS score, etc. And the risk factors of stroke recurrence were analyzed. Result: A total of 120 patients with large artery atherosclerotic cerebral infarction (age 71.42 ± 10.77 years) were collected, including 96 patients with hyperten-sion (80%);37 (30.83%), 46 (38.33%), 27 (22.5%), 32 (26.67%) and 43 (35.83%) patients had diabetes mellitus, coronary heart disease, cerebral infarction, hyperlipidemia and smoking history, respectively. The percentages were 30.83%, 38.33%, 22.5%, 26.67% and 35.83%. Recurrence of ischemic stroke occurred in 20% of patients during clinical follow-up. The statistical results of the related factors of stroke recurrence showed that gender, hypertension, diabetes mellitus, coronary heart disease, cerebral infarction, hyperlipidemia, smoking history, NIHSS score, treatment methods and so on were not statistically related to the recurrence. The correlation between the responsible vessels of cerebral infarction and the recurrence of stroke had statistical difference (X2 = 13.009, P = 0.025). Conclusion: In the district and county hospitals where interventional therapy has not been carried out yet, drug therapy is the main treatment for large artery atherosclerotic ischemic stroke, and there is a high recurrence rate. Recurrence of stroke is associated with the location of the vessel responsible for atherosclerotic stenosis.