本文關(guān)鍵詞： 急性缺血性梗死 TOAST分型 真實(shí)世界　出處：《河南中醫(yī)藥大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:1.分析目前真實(shí)世界中急性缺血性卒中急性期治療現(xiàn)狀;2.分析TOAST分型對治療腦卒中急性期預(yù)后的影響。方法:連續(xù)性記錄2015年3月至2016年1月因急性缺血性卒中在河南中醫(yī)學(xué)院第一附屬醫(yī)院和鄭州市中心醫(yī)院住院治療患者,調(diào)查真實(shí)臨床實(shí)踐中急性缺血性腦中風(fēng)患者的治療方案、治療結(jié)局、TOAST分型等,觀察時(shí)間為90天,并對其結(jié)果進(jìn)行統(tǒng)計(jì)學(xué)分析。結(jié)果:1.真實(shí)世界中患者接受溶栓治療的僅占2.2%,83%的患者給予腦保護(hù)劑治療,94%患者接受抗血小板治療,聯(lián)合治療方案中以四聯(lián)用藥、五聯(lián)用藥的患者比例較高,其中用中藥針劑+抗血小板藥物+改善腦循環(huán)藥物+神經(jīng)保護(hù)劑的患者比例為36%,使用中藥湯劑+中藥針劑+抗血小板藥物+改善腦循環(huán)藥物+神經(jīng)保護(hù)劑的患者為比例為26%,使用中藥湯劑+中藥針劑+抗血小板藥物+神經(jīng)保護(hù)劑的患者比例為24%。2.中醫(yī)院與西醫(yī)院治療前性別、年齡、NIHSS評分無統(tǒng)計(jì)學(xué)差異(P0.05)。藥物干預(yù)后出院時(shí)兩組神經(jīng)功能缺損(NIHSS)評分、神經(jīng)功能缺損好轉(zhuǎn)率、顯效、效差均無統(tǒng)計(jì)學(xué)意義。藥物干預(yù)后入院7天的基于中風(fēng)病患者報(bào)告的臨床結(jié)局評價(jià)量表(PRO)評分無統(tǒng)計(jì)學(xué)意義(P0.05),出院時(shí)兩組PRO評分具有明顯差異(P=0.0150.05)。3.TOAST分型各亞組性別、年齡無明顯差異(P0.05);各亞型間出入院時(shí)NIHSS評分及其好轉(zhuǎn)率進(jìn)行比較顯示:TOAST各亞型間患者入院時(shí)(P=0.0070.05)、出院時(shí)(P=0.0170.05)及好轉(zhuǎn)率(P=0.0230.05)比較差異具有統(tǒng)計(jì)學(xué)意義。其中心源性栓塞(CE)組較其它組NIHSS評分最高且好轉(zhuǎn)率最低,小動(dòng)脈閉塞性卒中(SAO)組與CE組結(jié)果相反。臨床療效結(jié)果顯示SAO明顯好于其它組,臨床治療效果最好(P0.01);大動(dòng)脈粥樣硬化性卒中(LAA)療效較CE、SOE好(P0.05);不明原因的缺血性卒中(SUE)療效與LAA、其他原因引起的缺血性卒中(SOE)比較無明顯差異(P0.05),CE與SOE、SUE比較臨床效果最差有統(tǒng)計(jì)學(xué)意義(P0.01)。復(fù)發(fā)率示CE與各亞組比較復(fù)發(fā)率最高(P0.05)有統(tǒng)計(jì)學(xué)意義。結(jié)論:1、真實(shí)世界中溶栓患者的比例依舊偏低,聯(lián)合用藥以四聯(lián)用藥比例最高;2、中醫(yī)藥治療對于改善患者PRO評分較單純西醫(yī)藥治療具有優(yōu)勢;3、TOAST分型中以小動(dòng)脈閉塞性卒中療效最好,心源性腦栓塞療效最差且復(fù)發(fā)率高,可以作為預(yù)測性指標(biāo)用于急性缺血性卒中治療過程中。
[Abstract]:Objective 1. To analyze the current situation of acute ischemic stroke treatment in the real world 2. To analyze the influence of TOAST classification on the prognosis of acute stroke. Methods: from March 2015 to January 2016, continuous records of acute ischemic stroke were recorded. Stroke patients were hospitalized at the first affiliated Hospital of Henan College of traditional Chinese Medicine and Zhengzhou Central Hospital, To investigate the actual clinical practice of patients with acute ischemic stroke treatment plan, treatment outcome and toast classification, observation time is 90 days, In the real world, only 2.2% of the patients received thrombolytic therapy, and 94% of the patients received antiplatelet therapy. The proportion of patients treated with five drugs is relatively high. The proportion of patients with traditional Chinese medicine injection antiplatelet drugs to improve cerebral circulation drug neuroprotective agent is 36. Patients who use traditional Chinese medicine decoction Chinese medicine injection antiplatelet drug to improve cerebral circulation drug neuroprotective agent patients. The proportion of patients treated with traditional Chinese medicine decoction, traditional Chinese medicine injection, anti-platelet drugs and neuroprotective agents was 24. 2. Sex before treatment in traditional Chinese medicine hospital and western hospital. There was no significant difference in NIHSS score between the two groups (P 0.05). When the two groups were discharged from hospital after drug intervention, NIHSS score, the improvement rate of neurological impairment and the effect were significant. There was no significant difference in the efficacy between the two groups. There was no significant difference in PRO scores between the two groups at the time of discharge, and there was a significant difference between the two groups at the time of discharge. 3. There was a significant difference between the two groups in the sex of each subgroup according to the classification of stroke patients on the 7th day after admission, and the difference was significant between the two groups at the time of discharge. There was no significant difference in age (P 0.05), and the comparison of the NIHSS score and the improvement rate among the subtypes showed that there were significant differences between the two subtypes (P = 0.0070.05, P = 0.0170.05) and the improvement rate (P = 0.0230.05), among which the cardiac embolism (CEE) was a significant difference between the two subtypes (P < 0.05, P < 0.05), and a significant difference was found between the two subtypes (P = 0.0070.05, P = 0.0170.05) and the improvement rate (P = 0.0230.05). The NIHSS score of the group was the highest and the rate of improvement was the lowest. The results of SAO group were contrary to those of CE group, and the clinical results showed that SAO was better than other groups. The effect of clinical treatment was better than that of CE-SOE (P 0.05); the effect of ischaemic stroke of unknown cause was better than that of Lai and other causes of ischemic stroke. There was no significant difference between P0.05CE and SOESUE compared with SOESUE. The recurrence rate showed that CE had the highest recurrence rate compared with each subgroup (P0.05). Conclusion: 1, the proportion of thrombolytic patients in the real world is still low. The proportion of combined use of four drugs was the highest. Traditional Chinese medicine treatment was superior to western medicine in improving the PRO score of patients. In the classification of small artery occlusive stroke, the effect of cardiogenic cerebral embolism was the worst and the recurrence rate was high. It can be used as predictive index in the treatment of acute ischemic stroke.
【學(xué)位授予單位】：河南中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R277.7

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