【摘要】：研究背景與目的:進(jìn)展性腦梗死(Stroke In Progression,SIP)是指急性腦梗死患者發(fā)病后在6h至1周內(nèi)神經(jīng)功能缺損癥狀逐漸進(jìn)展加重[1],發(fā)病后48h-72h內(nèi)發(fā)生為早期神經(jīng)功能惡化(Early neurological deterioration,END),在3d-7d發(fā)生則為延遲性神經(jīng)功能惡化(Delayed neurological deterioration,DND)[2]。影響END發(fā)生的相關(guān)危險(xiǎn)因素繁多,本研究通過回顧性分析END病患的相關(guān)臨床資料并討論分析END發(fā)生的相關(guān)危險(xiǎn)因素,為收治END病患時(shí)予以及時(shí)準(zhǔn)確地診療并對預(yù)防其發(fā)生提供一定的線索和依據(jù)。方法:本研究系統(tǒng)性回顧性分析2014年8月-2016年10月重慶醫(yī)科大學(xué)附二院神經(jīng)內(nèi)科收治的389例急性腦梗死患者的臨床資料。根據(jù)患者出現(xiàn)神經(jīng)功能惡化的時(shí)間將其分為END組和非END組。收集患者的一般資料(高血壓病史、糖尿病病史、腦梗死病史、吸煙史、性別和年齡)、入院時(shí)臨床表現(xiàn)(體溫及NIHSS評分)、實(shí)驗(yàn)室指標(biāo)(入院時(shí)空腹血糖及Fib、TC、TG、HDL、LDL)、影像學(xué)資料(梗死體積)。統(tǒng)計(jì)分析兩組病例相關(guān)臨床資料之間的差異,并分析討論可能影響病患END發(fā)生的相關(guān)危險(xiǎn)因素。結(jié)果:(1)389例急性腦梗死患者中有66例符合END的診斷標(biāo)準(zhǔn),發(fā)生率為16.97%。(2)一般臨床資料:END組與非END組在高血壓病史、糖尿病病史腦梗死病史、吸煙史、性別和年齡之間的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(3)臨床表現(xiàn):END組與非END組入院時(shí)體溫水平分別為36.768±0.572℃、36.526±0.641℃,其差異有統(tǒng)計(jì)學(xué)意義(P=0.003);兩組入院時(shí)NIHSS評分分別為9.76±5.969、5.97±4.799,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。(4)實(shí)驗(yàn)室檢查結(jié)果:入院空腹血糖高和Fib水平高在END組與非END組之間的差異有統(tǒng)計(jì)學(xué)意義(P=0.008、P=0.001);而TG、TC、HDL、LDL兩組之間的差異無統(tǒng)計(jì)學(xué)意義(P0.05)。(5)影像學(xué)檢查資料:END組與非END組梗死體積分別為47.676±47.873cm3、15.502±29.299 cm3,差異有統(tǒng)計(jì)學(xué)意義(P0.001)。(6)多因素logistic回歸分析高空腹血糖(P=0.011,OR=1.084,95%CI[1.018-1.153])、入院時(shí)NIHSS評分高(P0.001,OR=1.109,95%CI[1.049-1.171])、入院時(shí)體溫水平高(P=0.011,OR=2.532,95%CI[1.233-5.200])、Fib水平高(P=0.033,OR=1.353,95%CI[1.024-1.787])、梗死體積大(P0.001,OR=1.015,95%CI[1.008-1.023])是END發(fā)生的五個(gè)獨(dú)立危險(xiǎn)因素。結(jié)論:END是急性腦梗死患者常見臨床表現(xiàn),本研究表明影響END發(fā)生的危險(xiǎn)因素較多,其中入院時(shí)體溫高、入院時(shí)NIHSS評分高、空腹血糖水平高、Fib水平高及梗死體積大是END發(fā)生的獨(dú)立危險(xiǎn)因素。
[Abstract]:Background & AIM: progressive cerebral infarction (Stroke In Progression,SIP) refers to the progressive exacerbation of neurological deficit symptoms in patients with acute cerebral infarction within 6 hours to 1 week after the onset of acute cerebral infarction [1]. The occurrence of 3d-7d was delayed nerve function deterioration (Delayed neurological deterioration,DND) [2]. There are many risk factors associated with the occurrence of END. This study analyzed retrospectively the clinical data of END patients and discussed the risk factors associated with the occurrence of END. To provide clues and evidences for timely and accurate diagnosis and treatment of END patients. Methods: the clinical data of 389 patients with acute cerebral infarction treated in the Department of Neurology, second Hospital of Chongqing Medical University from August 2014 to October 2016 were analyzed retrospectively. Patients were divided into END group and non-END group according to the time of neurologic deterioration. Collect general data of patients (hypertension history, diabetes history, cerebral infarction history, smoking history, Sex and age, clinical manifestations at admission (body temperature and NIHSS score), laboratory indicators (fasting blood glucose and Fib,TC,TG,HDL,LDL on admission), imaging data (infarct volume). The differences of clinical data between two groups were statistically analyzed and the risk factors related to the occurrence of END were analyzed and discussed. Results: (1) 66 out of 389 patients with acute cerebral infarction met the diagnostic criteria of END, the incidence was 16.97. (2) the general clinical data of the two groups were hypertension history, diabetes history, cerebral infarction history and smoking history. There was no significant difference between sex and age (P0.05). (3). The body temperature of the two groups was 36.768 鹵0.572 鈩，

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