缺血性腦卒中患者疲勞發(fā)生率及其影響因素研究
發(fā)布時間：2019-05-29 01:55
【摘要】：目的本研究旨在調(diào)查首發(fā)缺血性腦卒中患者發(fā)病后2周、1個月、3個月、6個月的疲勞發(fā)生率,了解其變化趨勢,并分析不同時間點卒中后疲勞的影響因素,為下一步根據(jù)不同時間點的影響因素制定有針對性的干預(yù)措施、緩解患者疲勞提供理論依據(jù)。方法本研究為調(diào)查性研究。根據(jù)研究對象的納入和排除標(biāo)準(zhǔn),便利選取2015年10月~2016年5月在鄭州大學(xué)第一附屬醫(yī)院神經(jīng)內(nèi)科住院治療的440例缺血性腦卒中患者作為研究對象�；颊呷朐汉�2周內(nèi)完成基線調(diào)查。調(diào)查內(nèi)容包括社會人口學(xué)資料、卒中后疲勞發(fā)生情況及其臨床相關(guān)因素(疾病嚴(yán)重程度、血生化指標(biāo)、疼痛、卒中后抑郁、睡眠質(zhì)量、應(yīng)對方式等)。采用疲勞嚴(yán)重度量表評估患者的卒中后疲勞狀況。通過主觀資料、量表評估和客觀資料了解患者卒中后疲勞的影響因素。卒中后1個月、3個月、6個月分別進(jìn)行隨訪調(diào)查,內(nèi)容包括卒中后疲勞、MRS評分、疼痛、卒中后抑郁、睡眠質(zhì)量及應(yīng)對方式得分情況。應(yīng)用SPSS17.0統(tǒng)計軟件包進(jìn)行資料的統(tǒng)計分析,采用均數(shù)±標(biāo)準(zhǔn)差、頻數(shù)、百分比進(jìn)行數(shù)據(jù)的統(tǒng)計描述;采用χ2檢驗、Kruskal-Wallis非參數(shù)檢驗、兩獨立樣本t檢驗進(jìn)行疲勞的單因素分析;采用logistic回歸分析進(jìn)行疲勞影響因素的多因素分析,P0.05有統(tǒng)計學(xué)意義。結(jié)果1本研究共納入首發(fā)缺血性腦卒中患者440例,平均年齡為62.43±12.09歲,其中男性占59.5%,已婚占91.1%�；颊呷朐簳r輕微腦缺血者(NIHSS評分≤3分)占62.9%,無明顯殘障者(MRS2分)占33.9%,平均入院血糖為(6.08±1.51)mmol/L。經(jīng)過6個月的隨訪,失訪27例,失訪率6.14%;死亡11例,死亡率2.50%;再次發(fā)病23例,再發(fā)率5.23%。2發(fā)病后2周、1個月、3個月、6個月的疲勞得分分別為(3.53±1.57)、(3.61±1.44)、(3.59±1.51)、(3.57±1.48),卒中后疲勞發(fā)生率分別為36.8%、37.7%、33.3%、30.6%,隨時間呈現(xiàn)出逐漸下降趨勢。3卒中后疲勞的影響因素3.1發(fā)病后2周內(nèi)卒中后疲勞的影響因素:性別(OR=0.543,95%CI=0.326~0.905)、卒中前鍛煉(OR=0.470,95%CI=0.287~0.769)、卒中前疲勞(OR=3.173,95%CI=1.652~6.094)、MRS評分≥2(OR=2.481,95%CI=1.475~4.171)、卒中后抑郁(OR=2.383,95%CI=1.445~3.929)、入院血糖(OR=1.231,95%CI=1.040~1.458)。3.2發(fā)病后1個月卒中后疲勞的影響因素:居住地(OR=0.455,95%CI=0.278~0.744)、卒中前鍛煉(OR=0.574,95%CI=0.354~0.933)、卒中前疲勞(OR=2.926,95%CI=1.544~5.545)、MRS評分≥2(OR=2.483,95%CI=1.506~4.094)、卒中后抑郁(OR=2.846,95%CI=1.748~4.635)。3.3發(fā)病后3個月卒中后疲勞的影響因素:卒中前疲勞(OR=2.732,95%CI=1.435~5.167)、MRS評分≥2(OR=2.511,95%CI=1.519~4.149)、疼痛(OR=2.738,95%CI=1.296~5.791)、卒中后抑郁(OR=2.749,95%CI=1.678~4.503)。3.4發(fā)病后6個月卒中后疲勞的影響因素:卒中前疲勞(OR=2.405,95%CI=1.261~4.588)、MRS評分≥2(OR=2.162,95%CI=1.317~3.550)、疼痛(OR=2.656,95%CI=1.204~5.859)、卒中后抑郁(OR=3.141,95%CI=1.885~5.236)、消極應(yīng)對方式得分(OR=1.790,95%CI=1.144~2.800)。結(jié)論1缺血性腦卒中患者發(fā)病后2周、1個月、3個月、6個月的卒中后疲勞發(fā)生率隨時間呈現(xiàn)逐漸下降的趨勢。2卒中前鍛煉是缺血性腦卒中患者發(fā)病后2周和1個月卒中后疲勞的保護(hù)因素;高血糖是發(fā)病后2周卒中后疲勞的危險因素;中度及以上程度的疼痛是發(fā)病后3個月及6個月卒中后疲勞的危險因素;消極應(yīng)對方式得分是發(fā)病后6個月卒中后疲勞的危險因素,提示改善應(yīng)對方式可能是管理卒中后疲勞的一個新方向。卒中前疲勞、卒中后抑郁、存在明顯殘障(MRS評分≥2分)是發(fā)病后2周、1個月、3個月、6個月卒中后疲勞的共同危險因素,說明在腦卒中患者發(fā)病后6個月內(nèi)這三個危險因素持續(xù)存在,提示醫(yī)護(hù)人員應(yīng)盡早鼓勵患者積極治療卒中前疲勞相關(guān)疾病、改善心理衛(wèi)生、促進(jìn)軀體功能恢復(fù)。
[Abstract]:Objective The purpose of this study was to investigate the incidence of fatigue in 2 weeks,1 month,3 months and 6 months after the onset of the first-episode ischemic stroke, and to analyze the influencing factors of post-stroke fatigue at different time points. The aim of this paper is to develop targeted interventions based on the influencing factors of different time points, and to provide the theoretical basis for relieving the fatigue of the patients. Methods This study was an investigative study. According to the inclusion and exclusion criteria of the study object,440 patients with ischemic stroke from October 2015 to May 2016 in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University were selected as the subject of study. Baseline survey was completed within 2 weeks after the patient was admitted. The survey included socio-demographic data, post-stroke fatigue and its clinical-related factors (severity of the disease, blood biochemical indicators, pain, post-stroke depression, sleep quality, coping style, etc.). The post-stroke fatigue status of the patient was assessed using a fatigue severity gauge. The influence factors of post-stroke fatigue were studied by subjective data, scale assessment and objective data. Follow-up surveys were conducted for 1 month,3 months, and 6 months after stroke, including post-stroke fatigue, MRS score, pain, post-stroke depression, sleep quality, and coping style scores. The statistical analysis of the data was carried out using the SPSS17.0 statistical software package. The statistical description of the data was carried out by means of the standard deviation, frequency and percentage of the average number; the single factor analysis of the fatigue was carried out by the two independent samples t-test by using the two-step test, the Kruskal-Wallis non-static test and the two independent samples t-test; The multi-factor analysis of the fatigue-influencing factors was carried out by logistic regression analysis, and the statistical significance was found in P0.05. Results A total of 440 cases of first-time ischemic stroke were included in this study. The average age was 62.43 and 12.09 years, among which 59.5% and 91.1% were married. At the time of admission, the patients with mild cerebral ischemia (3score of NIHSS) accounted for 62.9%, 33.9% of the patients with no significant disability (MRS2 score) and (6.08 to 1.51) mmol/ L. After 6-month follow-up,27 cases were lost to follow-up, and the rate of failure to follow-up was 6.14%,11 cases of death, 2.50% of death rate,23 cases of re-occurrence and 5.23%, respectively. The fatigue scores were 3.53 (1.57), (3.61-1.44), (3.59-1.51), (3.57-1.48) in 2 weeks,1 month,3 months and 6 months after the onset of the disease. The incidence of post-stroke fatigue was 36.8%, 37.7%, 33.3% and 30.6%, respectively. The influence factors of post-stroke fatigue were: gender (OR = 0.543,95% CI = 0.326-0.905), pre-stroke exercise (OR = 0.470,95% CI = 0.287-0.769). Pre-stroke fatigue (OR = 3.173,95% CI = 1.652-6.094), MRS score:2 (OR = 2.481,95% CI = 1.475-4.171), post-stroke depression (OR = 2.383,95% CI = 1.445-3.929), admission blood glucose (OR = 1.231,95% CI = 1.040-1.458), pre-stroke exercise (OR = 0.455,95% CI = 0.278-0.744), pre-stroke exercise (OR = 0.574,95% CI = 0.354-0.933), prestroke fatigue (OR = 2.926,95% CI = 1.544-5.545), MRS score = 2 (OR = 2.483,95% CI = 1.506-4.094), Post-stroke depression (OR = 2.846,95% CI = 1.748 to 4.635). 3.3 The effect of post-stroke fatigue in 3 months after onset: pre-stroke fatigue (OR = 2.732,95% CI = 1.435-5.167), MRS score:2 (OR = 2.511,95% CI = 1.519-4.149), pain (OR = 2.738,95% CI = 1.296-5.791), post-stroke depression (OR = 2.749,95% CI = 1.268-4.503), and post-stroke depression (OR = 2.749,95% CI = 1.261-4.588), MRS score:2 (OR = 2.162,95% CI = 1.261-4.550), pain (OR = 2.162,95% CI = 1.317-3.550), pain (OR = 2.656,95% CI = 1.204-5.859), Post-stroke depression (OR = 3.141,95% CI = 1.885-5.236), negative coping style score (OR = 1.790,95% CI = 1.144-2.800). Conclusion The incidence of post-stroke fatigue in patients with ischemic stroke is decreasing with time in 2 weeks,1 month,3 months and 6 months, and the pre-stroke exercise is the protective factor of post-stroke fatigue in 2 and 1 months after the onset of ischemic stroke. Hyperglycemia is a risk factor for post-stroke fatigue after 2 weeks of onset; moderate and higher pain is a risk factor for post-stroke fatigue in 3 months and 6 months after onset; the negative coping style score is a risk factor for post-stroke fatigue in the 6-month post-onset stroke, It is suggested that the improvement of coping style may be a new way to manage post-stroke fatigue. The pre-stroke fatigue, post-stroke depression, and the presence of a significant disability (MRS score of 2 scores) were common risk factors for post-onset fatigue in 2 weeks,1 month,3 months, and 6 months, indicating that the three risk factors continued to exist within 6 months of the onset of stroke patients, It is suggested that the medical staff should encourage the patients to actively treat the pre-stroke fatigue related diseases, improve the mental health and promote the recovery of the physical function.
【學(xué)位授予單位】：鄭州大學(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：2487543
[Abstract]:Objective The purpose of this study was to investigate the incidence of fatigue in 2 weeks,1 month,3 months and 6 months after the onset of the first-episode ischemic stroke, and to analyze the influencing factors of post-stroke fatigue at different time points. The aim of this paper is to develop targeted interventions based on the influencing factors of different time points, and to provide the theoretical basis for relieving the fatigue of the patients. Methods This study was an investigative study. According to the inclusion and exclusion criteria of the study object,440 patients with ischemic stroke from October 2015 to May 2016 in the Department of Neurology of the First Affiliated Hospital of Zhengzhou University were selected as the subject of study. Baseline survey was completed within 2 weeks after the patient was admitted. The survey included socio-demographic data, post-stroke fatigue and its clinical-related factors (severity of the disease, blood biochemical indicators, pain, post-stroke depression, sleep quality, coping style, etc.). The post-stroke fatigue status of the patient was assessed using a fatigue severity gauge. The influence factors of post-stroke fatigue were studied by subjective data, scale assessment and objective data. Follow-up surveys were conducted for 1 month,3 months, and 6 months after stroke, including post-stroke fatigue, MRS score, pain, post-stroke depression, sleep quality, and coping style scores. The statistical analysis of the data was carried out using the SPSS17.0 statistical software package. The statistical description of the data was carried out by means of the standard deviation, frequency and percentage of the average number; the single factor analysis of the fatigue was carried out by the two independent samples t-test by using the two-step test, the Kruskal-Wallis non-static test and the two independent samples t-test; The multi-factor analysis of the fatigue-influencing factors was carried out by logistic regression analysis, and the statistical significance was found in P0.05. Results A total of 440 cases of first-time ischemic stroke were included in this study. The average age was 62.43 and 12.09 years, among which 59.5% and 91.1% were married. At the time of admission, the patients with mild cerebral ischemia (3score of NIHSS) accounted for 62.9%, 33.9% of the patients with no significant disability (MRS2 score) and (6.08 to 1.51) mmol/ L. After 6-month follow-up,27 cases were lost to follow-up, and the rate of failure to follow-up was 6.14%,11 cases of death, 2.50% of death rate,23 cases of re-occurrence and 5.23%, respectively. The fatigue scores were 3.53 (1.57), (3.61-1.44), (3.59-1.51), (3.57-1.48) in 2 weeks,1 month,3 months and 6 months after the onset of the disease. The incidence of post-stroke fatigue was 36.8%, 37.7%, 33.3% and 30.6%, respectively. The influence factors of post-stroke fatigue were: gender (OR = 0.543,95% CI = 0.326-0.905), pre-stroke exercise (OR = 0.470,95% CI = 0.287-0.769). Pre-stroke fatigue (OR = 3.173,95% CI = 1.652-6.094), MRS score:2 (OR = 2.481,95% CI = 1.475-4.171), post-stroke depression (OR = 2.383,95% CI = 1.445-3.929), admission blood glucose (OR = 1.231,95% CI = 1.040-1.458), pre-stroke exercise (OR = 0.455,95% CI = 0.278-0.744), pre-stroke exercise (OR = 0.574,95% CI = 0.354-0.933), prestroke fatigue (OR = 2.926,95% CI = 1.544-5.545), MRS score = 2 (OR = 2.483,95% CI = 1.506-4.094), Post-stroke depression (OR = 2.846,95% CI = 1.748 to 4.635). 3.3 The effect of post-stroke fatigue in 3 months after onset: pre-stroke fatigue (OR = 2.732,95% CI = 1.435-5.167), MRS score:2 (OR = 2.511,95% CI = 1.519-4.149), pain (OR = 2.738,95% CI = 1.296-5.791), post-stroke depression (OR = 2.749,95% CI = 1.268-4.503), and post-stroke depression (OR = 2.749,95% CI = 1.261-4.588), MRS score:2 (OR = 2.162,95% CI = 1.261-4.550), pain (OR = 2.162,95% CI = 1.317-3.550), pain (OR = 2.656,95% CI = 1.204-5.859), Post-stroke depression (OR = 3.141,95% CI = 1.885-5.236), negative coping style score (OR = 1.790,95% CI = 1.144-2.800). Conclusion The incidence of post-stroke fatigue in patients with ischemic stroke is decreasing with time in 2 weeks,1 month,3 months and 6 months, and the pre-stroke exercise is the protective factor of post-stroke fatigue in 2 and 1 months after the onset of ischemic stroke. Hyperglycemia is a risk factor for post-stroke fatigue after 2 weeks of onset; moderate and higher pain is a risk factor for post-stroke fatigue in 3 months and 6 months after onset; the negative coping style score is a risk factor for post-stroke fatigue in the 6-month post-onset stroke, It is suggested that the improvement of coping style may be a new way to manage post-stroke fatigue. The pre-stroke fatigue, post-stroke depression, and the presence of a significant disability (MRS score of 2 scores) were common risk factors for post-onset fatigue in 2 weeks,1 month,3 months, and 6 months, indicating that the three risk factors continued to exist within 6 months of the onset of stroke patients, It is suggested that the medical staff should encourage the patients to actively treat the pre-stroke fatigue related diseases, improve the mental health and promote the recovery of the physical function.
【學(xué)位授予單位】：鄭州大學(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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