【摘要】：腦梗死是腦動(dòng)脈短期內(nèi)出現(xiàn)狹窄或閉塞,導(dǎo)致供應(yīng)的腦組織發(fā)生缺血缺氧變性或死亡,出現(xiàn)相應(yīng)的神經(jīng)功能受損。腦梗死預(yù)后直接關(guān)系到患者生活質(zhì)量。但是目前腦梗死預(yù)后的影響因素復(fù)雜,導(dǎo)致臨床工作中對(duì)腦梗死患者預(yù)后的治療及指導(dǎo)存在爭議；而老年人通常就醫(yī)不及時(shí),伴發(fā)疾病多,病情復(fù)雜使預(yù)后較中青年人更差；忻州市有獨(dú)特的地域特點(diǎn),加之普遍對(duì)急性腦梗死的認(rèn)識(shí)不足,導(dǎo)致忻州市老年腦梗死有其特殊性。本研究旨在對(duì)忻州市影響老年腦梗死預(yù)后的相關(guān)因素進(jìn)行分析,對(duì)改善本市老年腦梗死預(yù)后提供理論依據(jù)。 目的：分析忻州市老年腦梗死短期預(yù)后影響因素。 方法：本研究采用橫斷面研究設(shè)計(jì),納入2011年12月-2013年6月197例發(fā)病72小時(shí)內(nèi)入院的老年腦梗死患者。以改良Rankin量表(modify Rankin Scale, mRS)評(píng)分分為預(yù)后良好組和預(yù)后不良組。分析兩組的個(gè)人特征(年齡、性別、吸煙、居住地)、既往史(冠心病、糖尿病、高血壓病)、合并癥(肺部感染)、NIHSS評(píng)分、空腹血糖、低密度脂蛋白、胱抑素、心電圖。對(duì)老年腦梗死短期預(yù)后用MRS評(píng)分進(jìn)行評(píng)估。對(duì)預(yù)后影響因素進(jìn)行單因素分析,對(duì)單因素分析有統(tǒng)計(jì)學(xué)意義的變量進(jìn)一步運(yùn)用非條件logistic回歸進(jìn)行多因素分析。 結(jié)果：單因素分析結(jié)果表明年齡、城鄉(xiāng)差異、冠心病史、高血壓病史、肺部感染、NIHSS評(píng)分、空腹血糖是影響老年腦梗死短期預(yù)后的獨(dú)立危險(xiǎn)因素(P)0.01)。房顫、低密度脂蛋白對(duì)老年腦梗死短期預(yù)后有影響(P0.05)。性別、吸煙、糖尿病史、胱抑素對(duì)老年腦梗死短期預(yù)后無影響(P0.05)。多因素分析結(jié)果發(fā)現(xiàn),NIHSS評(píng)分、高血壓病史、肺部感染對(duì)老年腦梗死短期預(yù)后有影響(P0.05),而年齡、城鄉(xiāng)差異、空腹血糖、冠心病史、房顫、低密度脂蛋白對(duì)老年腦梗死短期預(yù)后無影響(P0.05)。 結(jié)論：NIHSS評(píng)分、高血壓病史是影響老年腦梗死短期預(yù)后的獨(dú)立危險(xiǎn)因素。肺部感染是影響老年腦梗死短期預(yù)后的重要危險(xiǎn)因素,對(duì)這些危險(xiǎn)因素進(jìn)行積極干預(yù)可以改善忻州市老年腦梗死的預(yù)后。
[Abstract]:Cerebral infarction is a kind of cerebral artery stenosis or occlusion, which leads to ischemia and hypoxia degeneration or death of the supplied brain tissue, and the corresponding neurological impairment. The prognosis of cerebral infarction is directly related to the quality of life of patients. However, the factors influencing the prognosis of cerebral infarction are complicated, which leads to the controversy on the treatment and guidance of prognosis of patients with cerebral infarction in clinical work, while the elderly are usually not in time for medical treatment, accompanied by more diseases, and the complex condition makes the prognosis worse than that of young people. Xinzhou City has its unique regional characteristics, coupled with the general lack of understanding of acute cerebral infarction, leading to Xinzhou elderly cerebral infarction has its particularity. The purpose of this study was to analyze the factors related to the prognosis of senile cerebral infarction in Xinzhou City and to provide theoretical basis for improving the prognosis of senile cerebral infarction in Xinzhou City. Objective: to analyze the short-term prognostic factors of senile cerebral infarction in Xinzhou City. Methods: a cross-sectional study was conducted in 197 elderly patients with cerebral infarction admitted within 72 hours of onset from December 2011 to June 2013. The (modify Rankin Scale, mRS) score of modified Rankin scale was divided into good prognosis group and poor prognosis group. The personal characteristics (age, sex, smoking, residence), past history (coronary heart disease, diabetes, hypertension), complications (), NIHSS score of pulmonary infection, fasting blood glucose, low density lipoprotein, cystatin, electrocardiogram) were analyzed. The short-term prognosis of senile cerebral infarction was evaluated with MRS score. Univariate analysis of prognostic factors and multivariate analysis of unconditioned logistic regression were carried out for the variables with statistical significance in univariate analysis. Results: univariate analysis showed that age, urban and rural differences, history of coronary heart disease, history of hypertension, pulmonary infection, NIHSS score and fasting blood glucose were independent risk factors for short-term prognosis of cerebral infarction in elderly patients (P) 0.01). Atrial fibrillation and low density lipoprotein (LDL) had an effect on the short-term prognosis of senile cerebral infarction (P0.05). Sex, smoking, history of diabetes and cystatin had no effect on the short-term prognosis of cerebral infarction in the elderly (P0.05). Multivariate analysis showed that NIHSS score, history of hypertension and pulmonary infection had influence on short-term prognosis of cerebral infarction in the elderly (P0.05), but age, urban and rural differences, fasting blood glucose, history of coronary heart disease, atrial fibrillation, Low density lipoprotein had no effect on the short-term prognosis of cerebral infarction in the elderly (P0.05). Conclusion: NIHSS score and hypertension history are independent risk factors for short-term prognosis of senile cerebral infarction. Pulmonary infection is an important risk factor for the short-term prognosis of senile cerebral infarction. Active intervention of these risk factors can improve the prognosis of senile cerebral infarction in Xinzhou City.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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