多因素 Logistic分析对急性重症脑血管病患者死亡风险的预测

摘要

目的：分析急性重症脑血管病死亡的危险因素，预测死亡风险，以有效降低脑卒中患者的院内病死率。方法选择2008-10-2012-10于我院住院的急性重症脑血管病患者463例，采用回顾性分析方法，将研究对象的危险因素分为不可干预的Ⅰ类因素（性别、年龄、家族史）、可干预的Ⅱ类因素（高血压、脑卒中史、糖尿病、冠心病、慢性阻塞性肺病、高血脂、饮酒、吸烟）、Ⅲ类为并发症因素（上消化道出血、颅内再出血或梗死、肺部感染、心律失常、电解质紊乱、癫痫发作、多脏器功能障碍）和Ⅳ类为疾病特征因素（体温、脉搏、呼吸、收缩压、血糖、早期昏迷、Glasgow评分、溶栓、手术）共4个类别，逐项分类记录后采用多因素Logistic回归分析。结果年龄（＞70岁）、体温（＞38.5℃）、早期昏迷、高血压、脑卒中史、糖尿病、冠心病、慢性阻塞性肺病、上消化道出血、颅内再出血或梗死、肺部感染、电解质紊乱、癫痫发作、多脏器功能障碍和手术是独立危险因素，Glas-gow评分与死亡呈负相关。结论预测急性重症脑血管病死亡的关键因素，积极预防和治疗是降低重症脑血管病死亡风险的有效途径。%Objective To investigate and analyze the risk factors of mortality in patients with acute severe cerebrovascular disease ,in order to predict the death risk and reduce hospital mortality in acute cerebral apoplexy. Methods From July 2008 to July 2012 ,a total of 453 cases of patients with acute severe cerebrovascular disease in our hospital were selected ,and retrospec-tive method was performed. According to the characters of the different factors ,all of the risk factors were divided into four kinds. Type Ⅰ or the unchangeable factors were gender ,age ,family history ;type Ⅱ or the interfered factors included hyper-tension ,history of stroke ,diabetes ,coronary heart disease ,chronic obstructive pulmonary disease ,high blood lipids ,drinking and smoking ;type Ⅲ contained upper gastrointestinal hemorrhage ,intracranial re-hemorrhage or re-infarction ,arrhythmia , pulmonary infection ,electrolyte disturbances ,epilepsy and multiple organ dysfunction ;type Ⅳ were temperature ,pulse ,res-piration ,systolic blood pressure ,blood glucose ,early step coma ,Glasgow score ,thrombolysis and operation.Results Age (>70 years) ,temperature(> 38.5℃) ,early step coma ,hypertension ,history of stroke ,coronary heart disease ,diabetes , chronic obstructive pulmonary disease ,upper gastrointestinal hemorrhage ,intracranial re-hemorrhage or re-infarction ,pulmo-nary infection ,electrolyte disturbance ,seizures ,multiple organ dysfunction and operation were independent risk factors ,and the probability of death was negatively related to Glasgow scores.Conclusion Prediction of the key factors of death of acute se-vere cerebrovascular disease ,and active prevention and treatment ,was an effective way to reduce the risk of death.