缺血性脑卒中患者二级预防现状及再发脑卒中的危险因素分析

摘要

Objective To investigate the present situation of secondary prevention in patients with ischemic stroke ,and to analyze the risk factors in recurrent stroke and intervention strategy to reduce the incidence of recurrence. Methods 278 cases with stroke admitted to our hospital from June 2012 to June 2013 were retrospectively analyzed ,among which 61 patients with recurrent stroke consisted of observation group ,and 217 patients with non‐recurrent stroke formed the control group ,analyzing risk factors and intervention strategies of recurrent stroke by Logistic regression analysis.Results The incidence of recurrent stroke in patients with stroke was 24.10% (67/278). Type 2 diabetes and hypertension with 85.61% accounted for a signifi‐cant proportion among the risk factors of ischemic stroke ,which had low control rates of 49.58% and 49.16%. And the posi‐tive rates of overweight ,obesity and dysfunction of total cholesterol abnormal positive were higher ,with low control rate. Uni‐variate analysis showed that patients with ischemic stroke were closely associated with multiple stroke‐related factors including hypertension ,type 2 diabetes ,history of atrial fibrillation ,abnormal cholesterol. Further multiple factor analysis showed that the independent‐related risk factors of recurrent ischemic stroke contained the abnormality of total cholesterol (OR=3.472) , uncontrolled type 2 diabetes (OR= 2.237) ,uncontrolled hypertension(OR= 2.851)and history of atrial fibrillation(OR=1.945). Conclusion The control rates of type 2 diabetes and hypertension are very low in patients with ischemic stroke ,and the incidence of overweight and obesity are high ,evaluated total cholesterol ,history of atrial fibrillation and uncontrolled blood glucose and blood pressure are significantly associated with recurrent stroke.%目的：探讨缺血性脑卒中患者二级预防现状，并对其再发脑卒中危险因素及干预对策进行分析，以降低再发脑卒中的发生率。方法对2012‐06—2013‐06收治的278例脑卒中患者的临床资料进行回顾性分析，其中再发性脑卒中61例为观察组，未再发性脑卒中217例为对照组，采用Logistic逐步回归分析，分析其再发脑卒中的危险因素及干预对策。结果脑卒中患者再次发生脑卒中的发病率为24.10％（67／278），相关危险因素方面，2型糖尿病病史和高血压患病率较高，均为85.61％，控制率较低，分别为49.58％、49.16％，超重肥胖和总胆固醇水平异常的阳性率也较高，控制率也较低；单因素分析结果显示，缺血性脑卒中患者发生脑卒中有统计学意义的相关危险因素包括高血压、2型糖尿病、房颤病史、总胆固醇水平异常等相关因素；本研究中多因素分析进一步表明，再发缺血性脑卒中的独立相关危险因素是总胆固醇异常（OR＝3.472）、2型糖尿病血糖未控制（OR＝2.237），高血压未控制（OR＝2.851）和房颤病史（OR＝1.945）等。结论缺血性脑卒中患者在2型糖尿病和高血压控制率低，总胆固醇升高和超重肥胖发生率较高，总胆固醇水平升高、房颤病史及血糖、血压控制欠佳与脑卒中再发显著相关。