重症缺血性脑卒中预后相关影响因素分析

摘要

目的 探讨影响重症缺血性脑卒中(sIS)短期预后的相关因素.方法 回顾性分析143例缺血性脑卒中(IS)住院患者的一般资料和实验室检查,包括既往史、血常规、血生化、凝血象等指标,头颅CT或MRI影像资料,发病后的并发症.根据美国国立卫生研究院卒中量表(NIHSS)评分变化进行病情严重程度分类及预后判断.结果 143例IS患者中sIS者82例(57.3％),轻症缺血性脑卒中(mIS)61例(42.7％).82例sIS患者中,预后不良的发生率为73.2％ (60/82).sIS预后改善与预后不良组间入院收缩压、低密度脂蛋白(LDL-C)、随机血糖(Glu)比较差异有统计学意义(P＜0.05)；多因素Logistic回归分析显示,LDL-C水平升高是sIS早期不良预后的独立危险因素(OR=1.68,95％ CI:1.05～2.69),入院时收缩压相对升高对5IS的预后具有保护作用(OR=0.97,95％CI:0.05～1.00).mIS 30 d预后不良组与sIS 30 d预后不良组间房颤、卒中相关肺炎(SAP)、血白细胞数升高比较有统计学差异(P＜0.05)；多因素Logistic回归分析显示,房颤(OR=5.04,95％CI:1.31～9.63)、SAP(OR=3.23,95％CI:1.12～9.36)是IS早期不良预后的独立危险因素.结论 房颤、LDL-C水平升高、SAP是IS早期预后不良的独立危险因素.%Objective To explore the factors influencing the short-time prognosis of severe ischemic stroke (sIS). Methods The basic information of 143 patients with ischemic stroke (IS) was recorded, including the previous history, blood routine, blood biochemistry, coagulation indexes, cranial CT or MRI, IS complications, and the evaluation of sIS severity with score of NIHSS. Results Among the 143 patients, 82 (57. 3%) had sIS and 61 (42. 7%) had mild ischemic stroke (mIS). 60 eases had poor prognosis in the 82 cases with sIS, accounting for 73. 2% (60/82) . Single factor analysis revealed that significant difference was present in the systolic blood hypertension on admission , LDL-C level, and blood glucose between poor prognosis and good prognosis sIS patients. Logistic regression analysis revealed that high level of LDL-C (OR 1. 68, 95% CI: 1. 05-2. 69) was the independent risk factor for poor prognosis in patients with IS. The increased SBP showed benefits for the prognosis of sIS (OR 0.97, 95% CI: 0.05-1.00) . In mIS patients, single factor analysis revealed that atrial fibrillation (AT), stroke associated pneumonia (SAP) and white blood cell (WBC) elevation on admission were different significantly between poor prognosis and good prognosis patients. Logistic regression analysis revealed that AF (OR 5.04, 95% CI: 1.31-9.63) and SAP (OR 3. 23, 95%CI: 1.12-9.36) were the independent risk factors for poor prognosis in patients with sIS on early stage. Conclusions AF, higher level of LDL-C, and SAP were independent risk factors for poor prognosis in acute IS patients.