醒后卒中的臨床特征及發(fā)病時(shí)辰的探索性研究
發(fā)布時(shí)間：2018-07-23 20:00
【摘要】：醒后卒中(wake-up strokes, WUS),是指患者睡眠時(shí)發(fā)生的卒中,患者睡前無(wú)新發(fā)卒中癥狀,但在醒后患者本人或目擊者發(fā)現(xiàn)其出現(xiàn)卒中表現(xiàn)。WUS因發(fā)病時(shí)間不明確,影響了早期是否靜脈溶栓或血管內(nèi)治療等治療決策,據(jù)以往的報(bào)道,這部分患者在腦卒中人群中不占少數(shù),因此,研究醒后卒中的特征,探討WUS能否在積極的治療中獲益,就很有意義。WUS早期的不可干預(yù)性和時(shí)間延遲性,使其成為循證醫(yī)學(xué)的天然的暴露-終止效應(yīng)模型,很適合探討腦卒中早期的治療,祖國(guó)醫(yī)學(xué)認(rèn)為人體具有強(qiáng)大的抵抗力和自愈能力,中醫(yī)的治療方法就是調(diào)節(jié)整體平衡,激發(fā)人體自身的潛能,WUSi王好又是觀察疾病不受干擾的自然病程,以及人體的康復(fù)能力的自然模型。WUS與非醒后卒中(non-WU S)時(shí)間上的差異,亦可用于研究時(shí)間醫(yī)學(xué)以及祖國(guó)醫(yī)學(xué)的子午流注學(xué)說(shuō)。目的：了解WUS的臨床特征,通過(guò)“醒后”卒中與非“醒后”卒中的對(duì)比研究,探討急性缺血性腦卒中早期治療決策。方法：數(shù)據(jù)來(lái)源于廣東省中醫(yī)院腦病科大數(shù)據(jù)庫(kù),回顧性收集2012年1月1日至12月31日連續(xù)12個(gè)月內(nèi)的缺血性腦梗死患者病例384例,選取72h內(nèi)至我院急診或神經(jīng)科入院的急性缺血性腦卒中患者病例106例,錄入基線數(shù)據(jù)、危險(xiǎn)因素、實(shí)驗(yàn)室檢驗(yàn)、影像學(xué)檢查、以及與時(shí)間相關(guān)的信息,以NIHSS評(píng)分衡量神經(jīng)功能缺損程度。按是否醒后才出現(xiàn)新發(fā)卒中癥狀分為WUS組和non-WUS組。用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)分析,正態(tài)分布計(jì)量資料2組間用t檢驗(yàn),多組間用單因素方差分析；非正態(tài)分布計(jì)量資料采用秩和檢驗(yàn)；計(jì)數(shù)資料發(fā)生率或構(gòu)成比的比較采用卡方檢驗(yàn)。對(duì)比觀察WUS與non-WUS患者的臨床特點(diǎn),以及與發(fā)病時(shí)辰的關(guān)系,探討子午流注學(xué)說(shuō)的應(yīng)用。結(jié)果：106例急性缺血性腦卒中患者中, WUS患者36例,占34.0%,non-WUS患者70例,占66.0%。WUS患者既往的危險(xiǎn)因素明顯少于non-WUS患者(P=0.005),其中兩組間僅高尿酸血癥所占總?cè)藬?shù)百分比有統(tǒng)計(jì)學(xué)差異(P0.05)；WUS患者房顫及糖尿病所占總?cè)藬?shù)百分比也較低,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P=0.056,P=0.062),余高血壓病等危險(xiǎn)因素差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；兩組性別、入院時(shí)NIHSS評(píng)分、實(shí)驗(yàn)室檢驗(yàn)、檢查等差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。醒后卒中與臨床特征的Logistic回歸分析結(jié)果提示模型差異有統(tǒng)計(jì)學(xué)意義(χ2=8.31,P=0.004),診斷符合率68.9%,進(jìn)入方程的臨床特征有患病種數(shù),其OR=0.643,95%CI[0.467,0.886],分析提示,患病種數(shù)越多,發(fā)生醒后卒中的可能性越小,其他臨床特征差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。WUS患者3h內(nèi)、4.5h內(nèi)就診人數(shù)百分比明顯少于non-WUS患者(P=0.043、P=0.007)；24h內(nèi)就診的WUS患者病情較non-WUS患者輕,且越早就診的WUS患者病情越輕,而越早就診的non-WUS患者病情越重,但差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。WUS患者6：00～7：00(卯時(shí))發(fā)病人數(shù)最多,0：00-2：00發(fā)現(xiàn)卒中的患者NIHSS評(píng)分明顯低于4：00-6：00、6：00-8：00時(shí)段；non-WUS患者14：00～18：00為發(fā)病高峰；酉時(shí)NIHSS評(píng)分明顯大于辰(P=0.005)、未(P=0.006)、申(P=0.005)、亥時(shí)(P=0.017)。WUS與non-WUS患者發(fā)病季節(jié)分布有統(tǒng)計(jì)學(xué)差異(PO.05),WUS組與non-WUS組患者2組間NIHSS評(píng)分夏季和冬季有統(tǒng)計(jì)學(xué)差異,WUS患者夏季臨床表現(xiàn)較non-WUS患者更重(P=0.03),而冬季較non-WUS患者更輕(P=0.04)。結(jié)論：WUS有其獨(dú)特的臨床和時(shí)辰特征,西醫(yī)方面提示W(wǎng)US和non-WUS之間也許存在不同的發(fā)病機(jī)理及病程；中醫(yī)方面提示卯時(shí)或酉時(shí)治療的思路。
[Abstract]:After waking up stroke (wake-up strokes, WUS), it refers to the stroke in the patient's sleep. The patient has no new stroke symptoms before sleep, but after waking up, the patient or witness found that the occurrence of stroke in.WUS is not clear, which affects the early venous thrombolytic or intravascular treatment decisions. According to previous reports, this part of the patients There is no minority in the stroke population, so it is very important to study the characteristics of post wake stroke and to explore whether WUS can benefit from active treatment. It is very meaningful for the non intervention and time delay of early.WUS to make it a natural exposure termination effect model of evidence-based medicine. The body has strong resistance and self-healing ability. The treatment method of Chinese medicine is to adjust the overall balance and stimulate the potential of the human body. WUSi Wang is also a natural course to observe the undisturbed natural course of disease, and the difference between the natural model.WUS and the non wake apoplexy (non-WU S), and can also be used in the study of time medicine. Objective: to understand the clinical features of WUS and to explore the early treatment decision of acute ischemic stroke through the comparative study of "wake up" stroke and non "wake up" stroke. Methods: data from the large database of the Guangdong Province Traditional Chinese Medical Hospital encephalopathy, and a retrospective collection of 12 from January 1, 2012 to December 31st. In 384 patients with ischemic cerebral infarction within a month, 106 cases of acute ischemic stroke in the emergency or neurology department of our hospital were selected from 72h. Baseline data, risk factors, laboratory tests, imaging examinations, and time related information were used to measure the degree of neurological impairment by NIHSS score. The symptoms of new stroke were divided into group WUS and group non-WUS. Statistical analysis was carried out by SPSS17.0 software. 2 groups of normal distribution data were tested with t test, multiple groups were analyzed by single factor analysis of variance; non normal distribution measurement data were tested by rank sum test, and the ratio of counting data or composition ratio was compared with chi square test. WUS and non-WUS were compared and observed. The clinical characteristics of the patients, and the relationship with the time of the onset of the disease, the application of the meridian flow theory. Results: in 106 cases of acute ischemic stroke, 36 cases of WUS patients, 34% and 70 cases of non-WUS patients, the risk factors of 66.0%.WUS patients were significantly less than those of non-WUS patients (P=0.005), of which among the two groups, only hyperuricemia accounted for the total number of patients. There were statistical differences (P0.05), and the percentage of the total number of patients with atrial fibrillation and diabetes in WUS was also low, but there was no statistical significance (P=0.056, P=0.062), and there was no significant difference in the risk factors such as hypertension (P0.05). There was no statistical difference between the two groups of sex, NIHSS score, laboratory test, and examination (P0.05 The Logistic regression analysis of stroke and clinical characteristics suggested that the difference of the model was statistically significant (x 2=8.31, P=0.004), the diagnostic coincidence rate was 68.9%. The clinical characteristics of the equation were the number of diseases, and the OR=0.643,95%CI[0.467,0.886], the more the number of diseases, the less likely to wake up, the other clinical characteristics were poor. There was no statistically significant difference (P0.05).WUS patient 3h, the percentage of patients in 4.5H was significantly less than that of non-WUS patients (P=0.043, P=0.007), and WUS patients in 24h were lighter than non-WUS patients, and the younger the older the WUS patients were, the heavier the patient's condition was, but the difference was not statistically significant (6). The incidence of NIHSS was the most in 00 to 7:00. 0:00-2:00 found that the NIHSS score of the stroke patients was significantly lower than that of the 4:00-6:00,6:00-8:00 period; the non-WUS patient was at the peak of the onset of the onset; the NIHSS score at the eleventh hour was significantly greater than that of the Chen (P=0.005), P=0.006, P=0.005, and.WUS and non-WUS. There was a statistical difference in distribution (PO.05). The NIHSS scores between group WUS and group non-WUS were statistically different in summer and winter. The clinical manifestations of WUS patients in summer were heavier than those of non-WUS (P=0.03), but in winter were lighter than those of non-WUS patients (P=0.04). Conclusion: WUS has its unique bed and Chrono characteristics, and Western Medicine suggests that WUS and non-WUS may be between them. 瀛樺湪涓嶅悓鐨勫彂鐥呮満鐞嗗強(qiáng)鐥呯▼錛涗腑鍖繪柟闈㈡彁紺哄嵂鏃舵垨閰夋椂娌葷枟鐨勬，
本文編號(hào)：2140489
[Abstract]:After waking up stroke (wake-up strokes, WUS), it refers to the stroke in the patient's sleep. The patient has no new stroke symptoms before sleep, but after waking up, the patient or witness found that the occurrence of stroke in.WUS is not clear, which affects the early venous thrombolytic or intravascular treatment decisions. According to previous reports, this part of the patients There is no minority in the stroke population, so it is very important to study the characteristics of post wake stroke and to explore whether WUS can benefit from active treatment. It is very meaningful for the non intervention and time delay of early.WUS to make it a natural exposure termination effect model of evidence-based medicine. The body has strong resistance and self-healing ability. The treatment method of Chinese medicine is to adjust the overall balance and stimulate the potential of the human body. WUSi Wang is also a natural course to observe the undisturbed natural course of disease, and the difference between the natural model.WUS and the non wake apoplexy (non-WU S), and can also be used in the study of time medicine. Objective: to understand the clinical features of WUS and to explore the early treatment decision of acute ischemic stroke through the comparative study of "wake up" stroke and non "wake up" stroke. Methods: data from the large database of the Guangdong Province Traditional Chinese Medical Hospital encephalopathy, and a retrospective collection of 12 from January 1, 2012 to December 31st. In 384 patients with ischemic cerebral infarction within a month, 106 cases of acute ischemic stroke in the emergency or neurology department of our hospital were selected from 72h. Baseline data, risk factors, laboratory tests, imaging examinations, and time related information were used to measure the degree of neurological impairment by NIHSS score. The symptoms of new stroke were divided into group WUS and group non-WUS. Statistical analysis was carried out by SPSS17.0 software. 2 groups of normal distribution data were tested with t test, multiple groups were analyzed by single factor analysis of variance; non normal distribution measurement data were tested by rank sum test, and the ratio of counting data or composition ratio was compared with chi square test. WUS and non-WUS were compared and observed. The clinical characteristics of the patients, and the relationship with the time of the onset of the disease, the application of the meridian flow theory. Results: in 106 cases of acute ischemic stroke, 36 cases of WUS patients, 34% and 70 cases of non-WUS patients, the risk factors of 66.0%.WUS patients were significantly less than those of non-WUS patients (P=0.005), of which among the two groups, only hyperuricemia accounted for the total number of patients. There were statistical differences (P0.05), and the percentage of the total number of patients with atrial fibrillation and diabetes in WUS was also low, but there was no statistical significance (P=0.056, P=0.062), and there was no significant difference in the risk factors such as hypertension (P0.05). There was no statistical difference between the two groups of sex, NIHSS score, laboratory test, and examination (P0.05 The Logistic regression analysis of stroke and clinical characteristics suggested that the difference of the model was statistically significant (x 2=8.31, P=0.004), the diagnostic coincidence rate was 68.9%. The clinical characteristics of the equation were the number of diseases, and the OR=0.643,95%CI[0.467,0.886], the more the number of diseases, the less likely to wake up, the other clinical characteristics were poor. There was no statistically significant difference (P0.05).WUS patient 3h, the percentage of patients in 4.5H was significantly less than that of non-WUS patients (P=0.043, P=0.007), and WUS patients in 24h were lighter than non-WUS patients, and the younger the older the WUS patients were, the heavier the patient's condition was, but the difference was not statistically significant (6). The incidence of NIHSS was the most in 00 to 7:00. 0:00-2:00 found that the NIHSS score of the stroke patients was significantly lower than that of the 4:00-6:00,6:00-8:00 period; the non-WUS patient was at the peak of the onset of the onset; the NIHSS score at the eleventh hour was significantly greater than that of the Chen (P=0.005), P=0.006, P=0.005, and.WUS and non-WUS. There was a statistical difference in distribution (PO.05). The NIHSS scores between group WUS and group non-WUS were statistically different in summer and winter. The clinical manifestations of WUS patients in summer were heavier than those of non-WUS (P=0.03), but in winter were lighter than those of non-WUS patients (P=0.04). Conclusion: WUS has its unique bed and Chrono characteristics, and Western Medicine suggests that WUS and non-WUS may be between them. 瀛樺湪涓嶅悓鐨勫彂鐥呮満鐞嗗強(qiáng)鐥呯▼錛涗腑鍖繪柟闈㈡彁紺哄嵂鏃舵垨閰夋椂娌葷枟鐨勬，
本文編號(hào)：2140489
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