目的:探讨缺血性中风病证候要素与近期预后的关系。方法:动态采集缺血性中风病患者发病第1、7和14天的"缺血性中风证候要素诊断量表"(内风、内火、痰湿、血瘀、气虚、阴虚)评分及美国国立卫生研究院卒中量表(National Institu...目的:探讨缺血性中风病证候要素与近期预后的关系。方法:动态采集缺血性中风病患者发病第1、7和14天的"缺血性中风证候要素诊断量表"(内风、内火、痰湿、血瘀、气虚、阴虚)评分及美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分。以发病第14天的NIHSS评分作为缺血性中风病患者近期预后的评价指标,并依据评分进行分组(发病第14天NIHSS评分≥7作为近期预后不良组,NIHSS评分<7分为预后良好组),应用logistic回归模型探讨缺血性中风病急性期证候要素与近期预后的关系并利用受试者操作特征(receiver operating characteristic,ROC)曲线来评价模型的预测能力。根据logistic回归模型得到的结果,进一步应用两样本重复测量数据方差分析比较血瘀证组与非血瘀证组发病第1、7和14天的NIHSS评分。结果:发病第14天的血瘀证(比值比为2.924,95%置信区间为1.231～6.946,P=0.015)和发病第1天的神经功能缺损程度(比值比为1.956,95%置信区间为1.701～2.250,P=0.000)是预测缺血性中风病近期预后的独立危险因素。Logistic回归模型的ROC曲线下面积为0.95。从重复测量均数变化趋势图可看出,血瘀证患者的神经功能缺损程度较非血瘀证患者重,且其NIHSS分值在疾病过程中持续高于非血瘀证组。结论:血瘀证为缺血性中风近期预后的独立危险因素,临床上积极采取活血化瘀治疗将有助于改善疾病的近期预后。本研究还为实施缺血性中风病急性期中西医结合综合治疗方案动态证候干预提供了循证依据及数据支持。展开更多
BACKGROUND: Cerebrovascular accident(CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis ...BACKGROUND: Cerebrovascular accident(CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment. The symptoms that follow a stroke aren't signi? cant and depend on the area of the brain that has been affected and the amount of tissue damaged. Parameters for predicting long-term outcome in such patients have not been clearly delineated, therefore the aim of this study was to investigate this possibility and to test a system that might practicably be used routinely to aid management and predict outcomes of individual stroke patients.METHODS: A descriptive hospital-based study of the neurological symptoms and signs of 503 patients with ischemic stroke, including severe headache, seizure, eye movement disorder, pupil size, Glasgow Coma Scale(GCS), agitation were analyzed in this study.RESULTS: In the current study, dilated pupils, agitation, acute onset headache, lower GCS score, seizure, and eye gaze impairment had signi? cantly higher prevalence in hemorrhagic stroke patients(P<0.001). However, the rate of gradual progressive headache is significantly higher in ischemic stroke patients(P<0.001).CONCLUSION: Although this result provides reliable indicators for discrimination of stroke types, imaging studies are still the gold standard modality for diagnosis.展开更多
文摘目的:探讨缺血性中风病证候要素与近期预后的关系。方法:动态采集缺血性中风病患者发病第1、7和14天的"缺血性中风证候要素诊断量表"(内风、内火、痰湿、血瘀、气虚、阴虚)评分及美国国立卫生研究院卒中量表(National Institutes of Health Stroke Scale,NIHSS)评分。以发病第14天的NIHSS评分作为缺血性中风病患者近期预后的评价指标,并依据评分进行分组(发病第14天NIHSS评分≥7作为近期预后不良组,NIHSS评分<7分为预后良好组),应用logistic回归模型探讨缺血性中风病急性期证候要素与近期预后的关系并利用受试者操作特征(receiver operating characteristic,ROC)曲线来评价模型的预测能力。根据logistic回归模型得到的结果,进一步应用两样本重复测量数据方差分析比较血瘀证组与非血瘀证组发病第1、7和14天的NIHSS评分。结果:发病第14天的血瘀证(比值比为2.924,95%置信区间为1.231～6.946,P=0.015)和发病第1天的神经功能缺损程度(比值比为1.956,95%置信区间为1.701～2.250,P=0.000)是预测缺血性中风病近期预后的独立危险因素。Logistic回归模型的ROC曲线下面积为0.95。从重复测量均数变化趋势图可看出,血瘀证患者的神经功能缺损程度较非血瘀证患者重,且其NIHSS分值在疾病过程中持续高于非血瘀证组。结论:血瘀证为缺血性中风近期预后的独立危险因素,临床上积极采取活血化瘀治疗将有助于改善疾病的近期预后。本研究还为实施缺血性中风病急性期中西医结合综合治疗方案动态证候干预提供了循证依据及数据支持。
文摘BACKGROUND: Cerebrovascular accident(CVA) is the third leading cause of death and disability in developed countries. Anyone suspected of having a stroke should be taken immediately to a medical facility for diagnosis and treatment. The symptoms that follow a stroke aren't signi? cant and depend on the area of the brain that has been affected and the amount of tissue damaged. Parameters for predicting long-term outcome in such patients have not been clearly delineated, therefore the aim of this study was to investigate this possibility and to test a system that might practicably be used routinely to aid management and predict outcomes of individual stroke patients.METHODS: A descriptive hospital-based study of the neurological symptoms and signs of 503 patients with ischemic stroke, including severe headache, seizure, eye movement disorder, pupil size, Glasgow Coma Scale(GCS), agitation were analyzed in this study.RESULTS: In the current study, dilated pupils, agitation, acute onset headache, lower GCS score, seizure, and eye gaze impairment had signi? cantly higher prevalence in hemorrhagic stroke patients(P<0.001). However, the rate of gradual progressive headache is significantly higher in ischemic stroke patients(P<0.001).CONCLUSION: Although this result provides reliable indicators for discrimination of stroke types, imaging studies are still the gold standard modality for diagnosis.
