【摘要】：腦卒中可致死及致殘，其中非卒中原因住院患者在住院期間發(fā)生的卒中被稱(chēng)為院內(nèi)卒中[1]。腦卒中不僅造成人類(lèi)的死亡，幸存的患者也常伴有不同程度的肢體活動(dòng)障礙，因此腦卒中的預(yù)防及及早治療非常重要。由于院內(nèi)卒中的發(fā)生機(jī)制可能有醫(yī)療性因素及發(fā)生地點(diǎn)的特殊性，極易引發(fā)醫(yī)患矛盾，因此對(duì)院內(nèi)卒中的早期預(yù)防、診斷、治療等是非常重要的。 方法：對(duì)2012年1月-2013年1月的在吉林大學(xué)第一附屬醫(yī)院因非卒中原因住院，在住院期間發(fā)生腦卒中的115例患者進(jìn)行回顧性調(diào)查研究。統(tǒng)計(jì)的臨床資料主要包括性別、年齡、可能誘因、危險(xiǎn)因素、治療措施、出院轉(zhuǎn)歸等情況。從2012年1月-2013年1月以急性腦卒中為入院診斷的患者中隨機(jī)抽取115例組成院外卒中對(duì)照組，，比較院內(nèi)卒中及院外卒中的危險(xiǎn)因素、住院治療、出院轉(zhuǎn)歸等特點(diǎn)。 結(jié)果：1.院內(nèi)卒中共有115例，其中腦出血32例，腦梗死78例，短暫性腦缺血發(fā)作（transient ischemic attack，TIA）5例，男女之比為1：1.1，缺血性卒中患者的年齡比出血性卒中的年齡大（P0.05）。2.院內(nèi)出血性卒中主要分布于腫瘤中心14例（43.8%），院內(nèi)缺血性卒中主要分布于心血管內(nèi)科19例（16.5%），神經(jīng)外科18例（15.7%）。3.院內(nèi)發(fā)病主要集中于入院后1周（68.7%）�；颊弑患皶r(shí)發(fā)現(xiàn)且進(jìn)行有效處理的是67例（58.3%），各種原因?qū)е碌难舆t被發(fā)現(xiàn)的有48例（41.7%）。4.25.2%的院內(nèi)卒中患者是高齡者，45.2%患有高血壓，25.2%患者有血脂異常，29.6%患有糖尿病，29.6%是抽煙者，15.7%是飲酒者，17.4%有房顫病史，23.5%有既往腦血管病史，且這些危險(xiǎn)因素在缺血性卒中中更加常見(jiàn)，心房顫動(dòng)在出血性卒中及缺血性卒中中所占的比率有較大的統(tǒng)計(jì)學(xué)差異（缺血性：22.9%，出血性：3.1%，P0.02）。5.缺血性卒中中手術(shù)為主要致病因素，而出血性卒中中血小板低為主要致病因素。6.院內(nèi)卒中死亡率高，且出血性院內(nèi)卒中比缺血性院內(nèi)卒中的死亡率高，有統(tǒng)計(jì)學(xué)差異（P=0.001）。7.院內(nèi)外卒中比較，院內(nèi)卒中的房顫、心臟疾病、卒中后并發(fā)癥較院外卒中常見(jiàn)，呼吸機(jī)使用、監(jiān)護(hù)儀使用也是院內(nèi)卒中比較常見(jiàn)，院內(nèi)外卒中的患者出院時(shí)的改良的Rankin評(píng)分（Modified Rankin score，mRS）也有差別，院內(nèi)卒中患者的mRS評(píng)分5和6占據(jù)43.4%，而院外卒中中僅占12.2%。 結(jié)論：1、我院院內(nèi)卒中以缺血性卒中為主，但出血性卒中患者的死亡率高于缺血性卒中。2、院內(nèi)出血性卒中主要分布于腫瘤中心，主要診斷以白血病居多；院內(nèi)缺血性卒中主要分布于心血管內(nèi)科，主要診斷以冠心病居多。3、缺血性卒中患者發(fā)病因素主要為手術(shù)及心源性疾病，而出血性卒中發(fā)病因素主要為血小板減少。4、院內(nèi)卒中患者與院外卒中患者比較，院內(nèi)卒中患者卒中后并發(fā)癥多見(jiàn)，出院時(shí)神經(jīng)功能損害嚴(yán)重。5、院內(nèi)卒中患者在院期間接受腦血管檢查及血脂等腦血管病危險(xiǎn)因素篩查的較少，應(yīng)該加強(qiáng)對(duì)院內(nèi)卒中發(fā)病率較高的科室醫(yī)生對(duì)腦血管危險(xiǎn)因素篩查的意識(shí)，同時(shí)應(yīng)該加強(qiáng)對(duì)院內(nèi)卒中患者的及時(shí)救治。
[Abstract]:Stroke can be fatal and maimed, of which non-stroke causes are referred to as in-hospital stroke[1] in a stroke that occurs during hospitalization. Stroke not only causes the death of human, but also the patients who have survived are often accompanied by different degrees of limb movement disorder, so the prevention and early treatment of stroke is very important. Because the occurrence mechanism of the in-hospital stroke may have the medical factors and the particularity of the place, it is very important to cause the patient-patient conflict, so the early prevention, diagnosis, treatment and the like of the in-hospital stroke are very important. Methods: In January 2012 to January, 2013, the first Affiliated Hospital of Jilin University was hospitalized for non-stroke, and 115 patients with stroke during the hospitalization were retrospectively investigated. The clinical data of statistics mainly include sex, age, possible cause, risk factors, treatment measures, discharge outcome, etc. Case: 115 patients with stroke were randomly selected from January 2012 to January 2013 in the diagnosis of acute stroke, and the risk factors, hospitalization, discharge and the like in the in-hospital stroke and out-of-hospital stroke were compared. Features. Results: 1. There were 115 cases of stroke in the hospital, including 32 cases of cerebral hemorrhage, 78 cases of cerebral infarction, transient ischemic attack (TIA) and 5 cases of transient ischemic attack (TIA). The ratio of men and women was 1: 1. The age of patients with ischemic stroke was greater than that in hemorrhagic stroke (P0. 05). 2. The hemorrhagic stroke in the hospital was mainly distributed in 14 cases (43.8%) of the center of the tumor, 19 cases (16. 5%) and 18 (15) of neurosurgery. 7%). 3. The in-hospital incidence was mainly concentrated in 1 week after admission (6 8. 7%). The patient was found in time and the effective treatment was performed in 67 (5 The delay was found in 48 (45.7%). 4. 25. 2% of the in-hospital stroke patients were the elderly, 45. 2% had high blood pressure, 25. 2% of the patients had dyslipidemia, 29. 6% had diabetes, 29. 6% were smokers, 15. 7% were drinkers, 17. 4% had a history of atrial fibrillation, and 23. 5% had a prior history. The history of cerebrovascular disease and the risk factors were more common in ischemic stroke, and the ratio of atrial fibrillation in hemorrhagic stroke and ischemic stroke was significantly different (ischemic: 22. 9%, haemorrhagic: 3.1%, P0. 02). 5. The operation in the ischemic stroke is the main pathogenic factor, and the lower platelet in the hemorrhagic stroke is the main cause Disease factor. 6. The mortality of the in-hospital stroke is high, and the rate of stroke in the hemorrhagic in-hospital stroke is higher than that of the in-hospital stroke, and there is a statistical difference (P = 0. 0 01). 7. In-hospital stroke comparison, in-hospital stroke, atrial fibrillation, heart disease, post-stroke complications are common in the external stroke of the hospital, the use of the ventilator, the use of the monitor is also common in the in-hospital stroke, the improved Rankin score (Modified Rankin score, mRS, There was also a difference in the mRS scores of 5 and 6 in the in-hospital stroke patients to be 43.4%, while in the out-of-hospital stroke only 12. 2%. Conclusion: 1. The death rate of the patients with hemorrhagic stroke is higher than that of the ischemic stroke, but the incidence of hemorrhagic stroke in the hospital is higher than that of the ischemic stroke. in that department of cardiovascular internal medicine, the main diagnosis is coronary heart disease. 3, the incidence of ischemic stroke is mainly the operation and the cardiogenic disease, and the incidence of hemorrhagic stroke is mainly thrombocytopenia. 4. the in-hospital stroke patients are compared with the patients in the outside of the hospital, and the in-hospital stroke patients After stroke, there are more complications, and the neurological function is seriously impaired at the time of discharge. 5. In-hospital stroke patients receive less screening of the risk factors of cerebrovascular diseases such as cerebral vascular examination and blood fat during the hospital, and it is important to strengthen the department doctors with higher incidence of stroke in the hospital for cerebrovascular diseases. Consciousness of risk factor screening, and should be strengthened in the hospital
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R743.3

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