本文選題：急性腦卒中　切入點(diǎn)：不良預(yù)后　出處：《大連醫(yī)科大學(xué)》2013年碩士論文

【摘要】：背景和目的：急性腦卒中的預(yù)后評(píng)分(或模型)有很多的作用。但真正實(shí)現(xiàn)在臨床上使用前,必須認(rèn)真評(píng)價(jià)此類預(yù)后評(píng)分(模型)的可靠性、真實(shí)性及在臨床上的應(yīng)用價(jià)值。近2年發(fā)表的SOAR評(píng)分系統(tǒng)用來預(yù)測急性卒中預(yù)后的方法已在國外某些研究機(jī)構(gòu)中被證實(shí)有很好的預(yù)測能力,但至今還未在臨床上廣泛推廣和應(yīng)用。采用兩所三級(jí)甲等醫(yī)院神經(jīng)內(nèi)科的急性腦卒中患者的臨床數(shù)據(jù),對(duì)SOAR評(píng)分系統(tǒng)在臨床中的可靠性、可行性進(jìn)行一些列研究,目的在于了解該評(píng)分系統(tǒng)在的實(shí)際應(yīng)用價(jià)值。研究方法：對(duì)2013年10月-2015年2月在大連市友誼醫(yī)院、大連市第三人民醫(yī)院神經(jīng)內(nèi)科住院的腦梗死、腦出血住院患者進(jìn)行前瞻性登記。對(duì)登記的215例患者進(jìn)行前瞻性收集,并記錄SOAR評(píng)分所包含的4個(gè)變量,包括卒中類型(Stroke type)、牛津郡社區(qū)卒中分類(OCSP)、年齡(Age)和卒中前殘疾水平評(píng)分(mRS)預(yù)測急性卒中患者發(fā)病后第7天及出院時(shí)的死亡風(fēng)險(xiǎn),應(yīng)用樣本數(shù)據(jù)分別以卒中后第7天、出院時(shí)的功能殘障評(píng)分(mRS評(píng)分≥3)和死亡定義為不良結(jié)局事件；通過logistic回歸模型判斷SOAR評(píng)分對(duì)卒中后預(yù)后風(fēng)險(xiǎn)的預(yù)測價(jià)值；利用秩相關(guān)判斷該模型總分值與不良預(yù)后相關(guān)程度。研究結(jié)果：卒中后第7天和出院時(shí)的出現(xiàn)不良結(jié)局(mRs≥3分)的患者分別為47例(21.8%)和56例(26.4%),死亡23例(10.6%)。根據(jù)logistic模型可以驗(yàn)證：SOAR評(píng)分能夠預(yù)測急性腦卒中患者發(fā)病7天及發(fā)病及出院時(shí)的死亡風(fēng)險(xiǎn)；根據(jù)秩和分析相關(guān)系數(shù),可以肯定SOAR量表各變量相加總分?jǐn)?shù)與卒中后第7天、出院時(shí)的不良結(jié)局(死亡風(fēng)險(xiǎn))高度相關(guān),其相關(guān)系數(shù)分別為0.670、0.676。
[Abstract]:Background and objective: prognostic scores (or models) play a significant role in acute stroke. However, the reliability of such prognostic scores (models) must be carefully evaluated before they can be used in clinical practice. The methods used to predict the prognosis of acute stroke by SOAR scoring system published in recent two years have been proved to have good predictive ability in some foreign research institutions. But it has not been widely popularized and applied in clinic up to now. Using the clinical data of patients with acute cerebral apoplexy in neurology department of two Grade 3A hospitals, the reliability and feasibility of SOAR scoring system in clinic were studied. Objective to understand the practical application value of the scoring system. Methods: to study the cerebral infarction in Department of Neurology, Dalian third people's Hospital, Dalian Friendship Hospital from October 2013 to February 2015. Patients with intracerebral hemorrhage (ICH) were prospectively registered. The four variables included in the SOAR score were recorded. The stroke type Stroke type, Oxfordshire Community Stroke Classification (OCSP), and pre-stroke disability level score (mRSs) were used to predict the risk of death in patients with acute stroke on the 7th day after onset and at discharge. Sample data were used to measure the risk of death on the 7th day after stroke. Functional disability score (Mrs 鈮，

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