左右側大面積MCA梗死后腦心綜合征的發(fā)生率及其預后研究
發(fā)布時間：2018-09-13 14:48
【摘要】：目的1、研究左側和右側大面積大腦中動脈(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系;2、比較左側大面積MCA梗死和右側大面積MCA梗死患者的功能預后和生活質量,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量,進一步加強對此種特殊類型患者的認識,以期今后在臨床實踐中早評估、早治療、早康復,提高臨床救治水平,從而降低病殘率。方法采取前瞻性隊列研究,納入2014年9月至2016年9月就診于蘭州大學第二醫(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)于患者入院當日收集相關臨床資料,其中主要有人口學信息、既往史、個人史、主要的聯(lián)系方式,并行常規(guī)心電圖檢查,必要時進行心電監(jiān)護,發(fā)現(xiàn)心電圖異常者,需在2-7天內復查,并密切監(jiān)護患者。急診采血送檢相關指標,如心肌酶、離子及電解質(血鉀、血鈉),由神經專科醫(yī)生對患者進行美國國立衛(wèi)生院卒中量表(National Institute of Health Stroke Scale,NIHSS)的評分。(2)根據患者臨床表現(xiàn)及CT或MRI,按梗死部位將患者分為左側大面積MCA梗死組(LMCA梗死組)與右側大面積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)根據腦心綜合征的診斷標準,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月對患者進行腦卒中失語患者生活質量量表(Stroke and Aphasia Quality of life scale,SAQOL-39)的評分,評價隨訪患者的生活質量。(2)在發(fā)病6月時對隨訪患者進行改良的Rankin評分(modified Rankin Scale,m RS)的評估,評價患者功能預后,(m RS評分在0-2分之間,定義為預后良好,m RS評分在3-6分之間定義為預后不良),分析影響預后的危險因素及獨立危險因素。并比較LMCA梗死組與RMCA梗死組6個月的功能預后。3、統(tǒng)計學方法應用SPSS 19.0進行數據處理,以P0.05示差異有統(tǒng)計學意義。計數資料用率或構成比表示,組間比較用χ2檢驗或Fisher確切概率法。計量資料若符合正態(tài)分布,用均數±標準差((?)±s)表示,組間比較時,采用兩獨立樣本t檢驗;不符合正態(tài)分布時采用中位數、四分位間距表示,組間比較采用非參數檢驗。時間因素單獨效應分析用重復測量方差分析。分析半球不對稱性及腦心綜合征與6個月功能預后的相關性時用單變量及多變量logistic回歸。以上統(tǒng)計均采用雙側檢驗。結果發(fā)病急性期總共有118例患者符合納入標準,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),慢性基礎病(高血壓、糖尿病、高脂血癥)的患病率差異均無統(tǒng)計學意義(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評分在不同時間點都有統(tǒng)計學差異(p0.05),CCS組與非CCS組相比,患者SAQOL-39評分在不同時間點都無統(tǒng)計學差異(p0.05)。(2)根據6月時m RS評分,預后良好組與預后不良組基線資料比較,包括年齡、性別、生活史(吸煙、飲酒),慢性基礎病(高血壓、糖尿病、高脂血癥)患病率差異均無統(tǒng)計學意義(P0.05),入院時NIHSS評分、出院時NIHSS評分及梗死部位是預后不良的危險因素,多因素Logistic回歸分析結果顯示出院時NIHSS評分是6個月預后不良的獨立危險因素。結論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)計學差異(p0.05)。2、入院時NIHSS、出院時NIHSS、梗死部位均為預后不良的危險因素(p0.05),只有出院NIHSS評分是6個月預后不良的獨立危險因素(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評分在不同時間點都較RMCA梗死組低,即LMCA梗死組生活質量較差。
[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.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：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.
【學位授予單位】：蘭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R743.3
【參考文獻】
相關期刊論文 前10條
1 涂雪松;;缺血性腦卒中的流行病學研究[J];中國臨床神經科學;2016年05期
2 張昆;于倩;;不同部位急性腦梗死患者的心電圖異常及其與病情分型的關系[J];臨床和實驗醫(yī)學雜志;2016年07期
3 魏勇;;急性腦卒中患者發(fā)生腦心綜合征的臨床特點及對預后的影響[J];中國實用神經疾病雜志;2016年02期
4 李支援;呂風亞;張英;;大腦中動脈狹窄程度與不同急性腦梗死模式的相關性研究[J];國際神經病學神經外科學雜志;2015年03期
5 趙雪霞;宋靜杰;路雅寧;;兩側大腦半球急性腦梗死的比較性研究[J];中國實用神經疾病雜志;2015年10期
6 魏月;;腦心綜合征的研究現(xiàn)狀[J];西南軍醫(yī);2014年01期
7 孫智善;孟然;馮興中;曾現(xiàn)偉;賈建平;吉訓明;;腦心綜合征對急性缺血性腦卒中預后評價的臨床意義[J];中華臨床醫(yī)師雜志(電子版);2013年11期
8 談家紅;吳正福;;高血壓并發(fā)急性腦卒中患者心電圖改變臨床分析[J];重慶醫(yī)學;2013年14期
9 林潤;陳錦秀;馮木蘭;蔡麗嬌;鄧鳳;;腦卒中失語癥患者生活質量量表漢化及信效度測評[J];中華護理雜志;2013年04期
10 董宏;王勇強;趙桂森;張英;;磷酸肌酸在急性腦損傷患者腦心綜合征防治中的應用[J];山東醫(yī)藥;2013年12期
相關碩士學位論文 前1條
1 高媛麗;大腦皮質小膠質細胞IL-6，IL-1β不對稱分泌及LPS相關受體的研究[D];汕頭大學;2008年
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