目的 探索急性中-重度后循环梗死(Posterior circulation ischemia,PCI)预后不良的危险因素并进行初步模型分析.方法 纳入2019年7月至2021年1月咸宁市通山县中医医院收治的急性中-重度后循环脑梗死患者177例.以出院当天至出院后3个月进行随访,收集入院前一般临床资料、首发症状与体征、生化检查,美国国立卫生研究院卒中量表(National Insti-tutes of Health Stroke Scale,NIHSS)评分及治疗过程中的并发症等18个因素进行单因素分析,然后进行多元回归分析独立危险因素.结果 分析显示年龄＞60岁、有高血压、糖尿病、梗死灶为多灶、首诊NIHSS评分＞9分、伴肢体瘫痪及肺部感染是影响急性中-重度后循环脑梗死患者预后不良的独立危险因素(P＜0.05).其中采用糖尿病、首诊NIHSS评分、肺部感染3个因素构建的最佳模型,其区分预后良好与预后不良的ROC曲线下面积为0.803,灵敏度77.1%,特异度76.5%.结论 糖尿病的病史阳性、首诊NIHSS评分较高及住院期间肺部感染对急性中-重度PCI患者预后不良具有更加重要的参考价值.
Analysis of risk factors for poor prognosis in patients with acute moderate-severe posterior circulation infarction
Objective To explore the risk factors of poor prognosis in acute moderate-severe posterior circulation ischemia(PCI)and make a preliminary model analysis.Methods A total of 177 patients with acute moderate-to-severe posterior circulation cerebral infarction admitted to Tongshan County Traditional Chinese Medicine Hospital of Xianning City from July 2019 to January 2021 were included.Follow-up was conducted from the day of discharge to 3 months after discharge,and general clinical data before admission,first symptoms and signs,biochemical examinations,National Institutes of Health Stroke Scale(NIHSS)scores and complications dur-ing treatment were collected18 Single factor analysis was performed on each factor,and then multiple regression analysis was per-formed to analyze independent risk factors.Results The analysis shows that age>60 years,hypertension,diabetes,multi-focal infarc-tion,initial diagnosis NIHSS score>9,accompanied by limb paralysis and pulmonary infection are independent risks for poor prognosis in patients with acute moderate-to-severe posterior circulation cerebral infarction.factors(P<0.05).Among them,the best model was constructed using three factors:diabetes,first-diagnosis NIHSS score,and pulmonary infection.Its area under the ROC curve for distin-guishing good prognosis from poor prognosis was 0.803,with a sensitivity of 77.1%and a specificity of 76.5%.Conclusion A positive history of diabetes,higher NIHSS score at first diagnosis,and pulmonary infection during hospitalization have more important reference value for poor prognosis in patients with acute moderate-to-severe PCI.
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