左右側(cè)大面積MCA梗死后腦心綜合征的發(fā)生率及其預(yù)后研究
發(fā)布時間：2018-09-13 14:48
【摘要】：目的1、研究左側(cè)和右側(cè)大面積大腦中動脈(MCA)梗死后急性期腦心綜合征的發(fā)生率,探討大腦半球不對稱性與腦心綜合征的關(guān)系;2、比較左側(cè)大面積MCA梗死和右側(cè)大面積MCA梗死患者的功能預(yù)后和生活質(zhì)量,同時,比較發(fā)生腦心綜合征的患者與未發(fā)生腦心綜合征的患者的生活質(zhì)量,進(jìn)一步加強(qiáng)對此種特殊類型患者的認(rèn)識,以期今后在臨床實(shí)踐中早評估、早治療、早康復(fù),提高臨床救治水平,從而降低病殘率。方法采取前瞻性隊(duì)列研究,納入2014年9月至2016年9月就診于蘭州大學(xué)第二醫(yī)院的急性MCA大面積腦梗死住院患者118例。1、發(fā)病急性期患者病情評估(1)于患者入院當(dāng)日收集相關(guān)臨床資料,其中主要有人口學(xué)信息、既往史、個人史、主要的聯(lián)系方式,并行常規(guī)心電圖檢查,必要時進(jìn)行心電監(jiān)護(hù),發(fā)現(xiàn)心電圖異常者,需在2-7天內(nèi)復(fù)查,并密切監(jiān)護(hù)患者。急診采血送檢相關(guān)指標(biāo),如心肌酶、離子及電解質(zhì)(血鉀、血鈉),由神經(jīng)專科醫(yī)生對患者進(jìn)行美國國立衛(wèi)生院卒中量表(National Institute of Health Stroke Scale,NIHSS)的評分。(2)根據(jù)患者臨床表現(xiàn)及CT或MRI,按梗死部位將患者分為左側(cè)大面積MCA梗死組(LMCA梗死組)與右側(cè)大面積MCA梗死組(RMCA梗死組),比較兩組患者的基線資料及住院病死率。(3)根據(jù)腦心綜合征的診斷標(biāo)準(zhǔn),確定腦心綜合征的患者,比較LMCA梗死組和RMCA梗死組患者腦心綜合征的發(fā)生率。(4)根據(jù)是否發(fā)生腦心綜合征,將入組患者分為腦心綜合征組(CCS組)與非腦心綜合征組(非CCS組),比較兩組患者的基線資料,及住院病死率。2、發(fā)病1、3、6月時的隨訪(1)分別于患者發(fā)病1月、3月、6月對患者進(jìn)行腦卒中失語患者生活質(zhì)量量表(Stroke and Aphasia Quality of life scale,SAQOL-39)的評分,評價隨訪患者的生活質(zhì)量。(2)在發(fā)病6月時對隨訪患者進(jìn)行改良的Rankin評分(modified Rankin Scale,m RS)的評估,評價患者功能預(yù)后,(m RS評分在0-2分之間,定義為預(yù)后良好,m RS評分在3-6分之間定義為預(yù)后不良),分析影響預(yù)后的危險因素及獨(dú)立危險因素。并比較LMCA梗死組與RMCA梗死組6個月的功能預(yù)后。3、統(tǒng)計學(xué)方法應(yīng)用SPSS 19.0進(jìn)行數(shù)據(jù)處理,以P0.05示差異有統(tǒng)計學(xué)意義。計數(shù)資料用率或構(gòu)成比表示,組間比較用χ2檢驗(yàn)或Fisher確切概率法。計量資料若符合正態(tài)分布,用均數(shù)±標(biāo)準(zhǔn)差((?)±s)表示,組間比較時,采用兩獨(dú)立樣本t檢驗(yàn);不符合正態(tài)分布時采用中位數(shù)、四分位間距表示,組間比較采用非參數(shù)檢驗(yàn)。時間因素單獨(dú)效應(yīng)分析用重復(fù)測量方差分析。分析半球不對稱性及腦心綜合征與6個月功能預(yù)后的相關(guān)性時用單變量及多變量logistic回歸。以上統(tǒng)計均采用雙側(cè)檢驗(yàn)。結(jié)果發(fā)病急性期總共有118例患者符合納入標(biāo)準(zhǔn),在發(fā)病6個月時,完成隨訪的患者共有94例。1、急性期變量比較(1)LMCA梗死組與RMCA梗死組兩組患者的臨床基本資料,包括年齡、性別、生活史(吸煙、飲酒),慢性基礎(chǔ)病(高血壓、糖尿病、高脂血癥)的患病率差異均無統(tǒng)計學(xué)意義(P0.05)。(2)LMCA梗死組與RMCA梗死組相比,LMCA梗死組NIHSS評分高于RMCA梗死組(P0.05),兩組患者CCS發(fā)生率無明顯差異(72.2%vs 65.6%,P0.05),住院期間病死率無統(tǒng)計學(xué)差異(20.4%vs 12.5%,P0.05)。(3)CCS組與非CCS組相比較發(fā)現(xiàn),兩組患者的基本基線資料包括年齡、性別、生活史(吸煙、飲酒),慢性基礎(chǔ)病史(高血壓、糖尿病、高脂血癥)的患病率、住院NIHSS評分、住院病死率均無統(tǒng)計學(xué)差異(P0.05);按梗死部位分層后,CCS組與非CCS組患者在住院時間、入院NIHSS評分、出院NIHSS評分方面均無統(tǒng)計學(xué)差異(P0.05)。2、發(fā)病1、3、6個月訪視變量比較(1)LMCA梗死組與RMCA梗死組相比,患者SAQOL-39評分在不同時間點(diǎn)都有統(tǒng)計學(xué)差異(p0.05),CCS組與非CCS組相比,患者SAQOL-39評分在不同時間點(diǎn)都無統(tǒng)計學(xué)差異(p0.05)。(2)根據(jù)6月時m RS評分,預(yù)后良好組與預(yù)后不良組基線資料比較,包括年齡、性別、生活史(吸煙、飲酒),慢性基礎(chǔ)病(高血壓、糖尿病、高脂血癥)患病率差異均無統(tǒng)計學(xué)意義(P0.05),入院時NIHSS評分、出院時NIHSS評分及梗死部位是預(yù)后不良的危險因素,多因素Logistic回歸分析結(jié)果顯示出院時NIHSS評分是6個月預(yù)后不良的獨(dú)立危險因素。結(jié)論1、大面積梗死患者急性期CCS發(fā)病率68.6%,其中LMCA梗死組與RMCA梗死組CCS發(fā)病率無統(tǒng)計學(xué)差異(p0.05)。2、入院時NIHSS、出院時NIHSS、梗死部位均為預(yù)后不良的危險因素(p0.05),只有出院NIHSS評分是6個月預(yù)后不良的獨(dú)立危險因素(P=0.000)。3、存活患者在發(fā)病1、3、6月時,SAQOL-39評分在不斷增加,即生活質(zhì)量隨時間的延長都在改善,但LMCA梗死組患者SAQOL-39評分在不同時間點(diǎn)都較RMCA梗死組低,即LMCA梗死組生活質(zhì)量較差。
[Abstract]:Objective 1. To study the incidence of acute cerebral-cardiac syndrome after left and right large-area middle cerebral artery (MCA) infarction, and to explore the relationship between cerebral hemispheric asymmetry and cerebral-cardiac syndrome; 2. To compare the functional prognosis and quality of life in patients with large-area left MCA infarction and large-area right MCA infarction, and to compare the incidence of cerebral-cardiac syndrome. Methods A prospective cohort study was conducted to enroll patients in Lanzhou University from September 2014 to September 2016. 118 inpatients with acute MCA massive cerebral infarction in the Second Hospital were studied. 1. The evaluation of patients'condition in the acute stage (1) Collection of clinical data on the day of admission, including demographic information, past history, personal history, main contact methods, routine electrocardiogram examination, electrocardiogram monitoring if necessary, found abnormal electrocardiogram. Emergency blood collection, such as myocardial enzymes, ions and electrolytes (blood potassium, blood sodium), was performed by neurologists on patients with the National Institute of Health Stroke Scale (NIHSS). (2) According to clinical manifestations and CT or MRI, according to infarction The patients were divided into left large area MCA infarction group (LMCA infarction group) and right large area MCA infarction group (RMCA infarction group). The baseline data and in-hospital mortality were compared between the two groups. (3) According to the diagnostic criteria of Cerebrocardiac syndrome, the patients with cerebrocardiac syndrome were determined, and the incidence of cerebrocardiac syndrome was compared between LMCA infarction group and RMCA infarction group. (4) According to the occurrence of Cerebrocardiac syndrome, the patients were divided into two groups: cerebral-cardiac syndrome group (CCS group) and non-cerebral-cardiac syndrome group (non-CCS group). The baseline data and in-hospital mortality of the two groups were compared. 2. Follow-up visits at 1, 3, and 6 months of onset were conducted in patients with aphasia after stroke in January, March and June, respectively. Stroke and Aphasia Quality of Life Scale (SAQOL-39) scores were used to evaluate the quality of life of the follow-up patients. The functional prognosis of LMCA infarction group and RMCA infarction group at 6 months was compared. 3. Statistical method SPSS 19.0 was used for data processing, and P 0.05 was used for statistical analysis. The counting data was expressed by_2 test or Fisher exact. Probabilistic method: If the measurement data conform to the normal distribution, the mean (?) + standard deviation (?) + s is used, and the two independent samples t test is used for comparison between groups; the median is used for non-normal distribution, the quartile spacing is used for comparison, and the non-parametric test is used for comparison between groups. Univariate and multivariate logistic regression were used to analyze the correlation between sex and 6-month functional prognosis in patients with acute cerebral heart syndrome. There was no significant difference between the two groups in the basic clinical data, including age, sex, life history (smoking, drinking), chronic underlying diseases (hypertension, diabetes, hyperlipidemia). (2) Compared with the RMCA infarction group, the NIHSS score of the LMCA infarction group was higher than that of the RMCA infarction group (P 0.05). The incidence of CCS in the two groups was not clear. There was significant difference (72.2% vs 65.6%, P 0.05). There was no significant difference in mortality during hospitalization (20.4% vs 12.5%, P 0.05). (3) Compared with the non-CCS group, the baseline data of the two groups included age, sex, life history (smoking, drinking), prevalence of chronic basic disease (hypertension, diabetes, hyperlipidemia), NIHSS score, hospitalization disease. There was no significant difference in the fatality rate (P 0.05). There was no significant difference in hospitalization time, NIHSS score and NIHSS score between the CCS group and the non-CCS group (P 0.05). There was no significant difference in SAQOL-39 score between CCS group and non-CCS group at different time points (p0.05). (2) According to the m RS score at 6 months, the baseline data of patients with good prognosis were compared with those of patients with poor prognosis, including age, sex, life history (smoking, drinking), prevalence of chronic underlying diseases (hypertension, diabetes, hyperlipidemia). There was no significant difference (P 0.05). The NIHSS score at admission, NIHSS score at discharge and infarction site were risk factors for poor prognosis. Multivariate logistic regression analysis showed that NIHSS score at discharge was an independent risk factor for poor prognosis at 6 months. There was no significant difference in the incidence of CCS in infarction group A (p0.05). NIHSS at admission, NIHSS at discharge, and infarction site were risk factors for poor prognosis (p0.05). Only NIHSS score at discharge was an independent risk factor for poor prognosis in 6 months (P = 0.000). SAQOL-39 score was increasing in survivors at 1, 3, and 6 months of onset, i.e, quality of life was increasing with time. But the SAQOL-39 score of LMCA infarction group was lower than that of RMCA infarction group at different time points, that is, the quality of life of LMCA infarction group was worse.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3
本文編號：2241485
[Abstract]:Objective 1. To study the incidence of acute cerebral-cardiac syndrome after left and right large-area middle cerebral artery (MCA) infarction, and to explore the relationship between cerebral hemispheric asymmetry and cerebral-cardiac syndrome; 2. To compare the functional prognosis and quality of life in patients with large-area left MCA infarction and large-area right MCA infarction, and to compare the incidence of cerebral-cardiac syndrome. Methods A prospective cohort study was conducted to enroll patients in Lanzhou University from September 2014 to September 2016. 118 inpatients with acute MCA massive cerebral infarction in the Second Hospital were studied. 1. The evaluation of patients'condition in the acute stage (1) Collection of clinical data on the day of admission, including demographic information, past history, personal history, main contact methods, routine electrocardiogram examination, electrocardiogram monitoring if necessary, found abnormal electrocardiogram. Emergency blood collection, such as myocardial enzymes, ions and electrolytes (blood potassium, blood sodium), was performed by neurologists on patients with the National Institute of Health Stroke Scale (NIHSS). (2) According to clinical manifestations and CT or MRI, according to infarction The patients were divided into left large area MCA infarction group (LMCA infarction group) and right large area MCA infarction group (RMCA infarction group). The baseline data and in-hospital mortality were compared between the two groups. (3) According to the diagnostic criteria of Cerebrocardiac syndrome, the patients with cerebrocardiac syndrome were determined, and the incidence of cerebrocardiac syndrome was compared between LMCA infarction group and RMCA infarction group. (4) According to the occurrence of Cerebrocardiac syndrome, the patients were divided into two groups: cerebral-cardiac syndrome group (CCS group) and non-cerebral-cardiac syndrome group (non-CCS group). The baseline data and in-hospital mortality of the two groups were compared. 2. Follow-up visits at 1, 3, and 6 months of onset were conducted in patients with aphasia after stroke in January, March and June, respectively. Stroke and Aphasia Quality of Life Scale (SAQOL-39) scores were used to evaluate the quality of life of the follow-up patients. The functional prognosis of LMCA infarction group and RMCA infarction group at 6 months was compared. 3. Statistical method SPSS 19.0 was used for data processing, and P 0.05 was used for statistical analysis. The counting data was expressed by_2 test or Fisher exact. Probabilistic method: If the measurement data conform to the normal distribution, the mean (?) + standard deviation (?) + s is used, and the two independent samples t test is used for comparison between groups; the median is used for non-normal distribution, the quartile spacing is used for comparison, and the non-parametric test is used for comparison between groups. Univariate and multivariate logistic regression were used to analyze the correlation between sex and 6-month functional prognosis in patients with acute cerebral heart syndrome. There was no significant difference between the two groups in the basic clinical data, including age, sex, life history (smoking, drinking), chronic underlying diseases (hypertension, diabetes, hyperlipidemia). (2) Compared with the RMCA infarction group, the NIHSS score of the LMCA infarction group was higher than that of the RMCA infarction group (P 0.05). The incidence of CCS in the two groups was not clear. There was significant difference (72.2% vs 65.6%, P 0.05). There was no significant difference in mortality during hospitalization (20.4% vs 12.5%, P 0.05). (3) Compared with the non-CCS group, the baseline data of the two groups included age, sex, life history (smoking, drinking), prevalence of chronic basic disease (hypertension, diabetes, hyperlipidemia), NIHSS score, hospitalization disease. There was no significant difference in the fatality rate (P 0.05). There was no significant difference in hospitalization time, NIHSS score and NIHSS score between the CCS group and the non-CCS group (P 0.05). There was no significant difference in SAQOL-39 score between CCS group and non-CCS group at different time points (p0.05). (2) According to the m RS score at 6 months, the baseline data of patients with good prognosis were compared with those of patients with poor prognosis, including age, sex, life history (smoking, drinking), prevalence of chronic underlying diseases (hypertension, diabetes, hyperlipidemia). There was no significant difference (P 0.05). The NIHSS score at admission, NIHSS score at discharge and infarction site were risk factors for poor prognosis. Multivariate logistic regression analysis showed that NIHSS score at discharge was an independent risk factor for poor prognosis at 6 months. There was no significant difference in the incidence of CCS in infarction group A (p0.05). NIHSS at admission, NIHSS at discharge, and infarction site were risk factors for poor prognosis (p0.05). Only NIHSS score at discharge was an independent risk factor for poor prognosis in 6 months (P = 0.000). SAQOL-39 score was increasing in survivors at 1, 3, and 6 months of onset, i.e, quality of life was increasing with time. But the SAQOL-39 score of LMCA infarction group was lower than that of RMCA infarction group at different time points, that is, the quality of life of LMCA infarction group was worse.
【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743.3
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