摘要
目的:探讨醒后卒中患者的临床特征和转归。方法:连续回顾性纳入2019年1月至12月在惠州市中心人民医院神经内科住院治疗的急性缺血性卒中患者。发病后90 d时利用改良Rankin量表评估患者转归,0~2分定义为转归良好,>2分定义为转归不良。采用多变量logistic回归分析确定醒后卒中患者转归不良的影响因素。结果:共纳入356例急性缺血性卒中患者,醒后卒中组97例(27.2%),非醒后卒中组259例(72.8%)。醒后卒中组入院时美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分以及心房颤动、中重度卒中和心源性栓塞患者的构成比显著高于非醒后卒中组,而小动脉闭塞患者的构成比显著低于非醒后卒中组(P均<0.05);醒后卒中组转归不良的患者构成比显著高于非醒后卒中组(36.1%对24.7%;χ^(2)=4.546,P=0.033)。在醒后卒中组中,62例(63.9%)转归良好,35例(36.1%)转归不良;转归不良亚组入院时NIHSS评分以及心房颤动和中重度卒中患者的构成比显著高于转归良好亚组,而接受静脉溶栓和血管内机械血栓切除治疗的患者构成比均显著低于转归良好亚组(P均<0.05)。多变量logistic回归分析显示,中重度卒中[优势比(odds ratio,OR)6.674,95%置信区间(confidence interval,CI)2.223~20.034;P=0.001]与醒后卒中患者转归不良独立相关,而静脉溶栓(OR 0.102,95%CI 0.017~0.630;P=0.014)和血管内机械血栓切除(OR 0.108,95%CI 0.023~0.506;P=0.005)与醒后卒中患者转归良好独立相关。结论:醒后卒中患者的心源性栓塞患者的比例更高、临床症状更严重且转归不良发生率更高。入院时卒中严重程度与醒后卒中短期转归不良相关,而静脉溶栓和血管内机械血栓切除治疗可改善其转归。
Objective To investigate the clinical characteristics and outcomes in patients with wake-up stroke.Methods From January 2019 to December 2019,consecutive patients with acute ischemic stroke admitted to the Department of Neurology,Huizhou Municipal Central Hospital were enrolled retrospectively.The modified Rankin Scale was used to evaluate the outcome of patients at 90 d after the onset.0 to 2 was defined as a good outcome,and>2 was defined as a poor outcome.Multivariate logistic regression analysis was used to determine the factors affecting the poor outcome of patients with wake-up stroke.Results A total of 356 patients with acute ischemic stroke were enrolled,including 97(27.2%)wake-up stroke,and 259(72.8%)non-wake-up stroke.The National Institutes of Health Stroke Scale(NIHSS)score at admission and the proportion of patients with atrial fibrillation,moderate to severe stroke and cardiogenic embolism in the wake-up stroke group were significantly higher than those of the non-wake-up stroke group,and the proportion of patients with small artery occlusion was significantly lower than that in the non-wake-up stroke group(all P<0.05).Moreover,the proportion of patients with poor outcome in the wake-up stroke group was significantly higher than that in the non-wake-up stroke group(36.1%vs.24.7%;χ^(2)=4.546,P=0.033).In the wake-up stroke group,62 patients(63.9%)had a good outcome,and 35(36.1%)had a poor outcome.The NIHSS score at admission and the proportion of patients with atrial fibrillation and moderate to severe stroke in the subgroup with poor outcome were significantly higher than those in the subgroup with good outcome,and the proportion of patients receiving intravenous thrombolysis and mechanical thrombectomy was significantly lower than those in the good outcome subgroup(all P<0.05).Multivariate logistic regression analysis showed that moderate to severe stroke(odds ratio[OR]6.674,95%confidence interval[CI]2.223-20.034;P=0.001)was independently associated with the poor outcome in patients with wake-up st
作者
王立志
罗伟良
罗轩文
陈敏锐
曾玮
Wang Lizhi;Luo Weiliang;Luo Xuanwen;Chen Minrui;Zeng Wei(Department of Neurology,Huizhou Municipal Central Hospital,Huizhou 516001,China)
出处
《国际脑血管病杂志》
2021年第4期241-245,共5页
International Journal of Cerebrovascular Diseases
基金
广东省惠州市科技计划项目(2014Y016)。
关键词
卒中
脑缺血
疾病严重程度指数
心房颤动
颅内栓塞和血栓形成
血栓溶解疗法
血栓切除术
治疗结果
Stroke
Brain ischemia
Severity of illness index
Atrial fibrillation
Intracranial embolism and thrombosis
Thrombolytic therapy
Thrombectomy
Treatment outcome
