摘要
目的 分析因心血管病住院并发生院内卒中的患者人群特点.方法 本文为横断面研究.收集2023年1月至9月因心血管病入住阜外医院、经神经内科确诊为院内卒中患者.将患者分为未手术组、外科手术组及介入手术组,分析和比较3组患者的基线资料、卒中严重程度及转归情况.结果 纳入患者114例,其中男78例(68.4％,78/114),年龄(62±12)岁.其中未手术组21例,外科手术组49例,介入手术组44例.未手术组与外科手术组、介入手术组的年龄[(56±16)岁对(61±11)对(65±11)岁,P=0.021]、心力衰竭患病率[57.1％(12/21)对 10.2％(5/49)对 2.3％(1/44),P＜0.001]、收缩压[(112±18)mmHg 对(125±20)mmHg 对(129±17)mmHg,P=0.004]、左心室舒张末期内径[(61±12)mm 对(49±7)mm 对(50±7)mm,P＜0.001]、左心室射血分数[39％±15％对 58％±10％对60％±9％,P＜0.001]、总 胆固醇[(4.69±1.15)mmol/L 对(3.65±1.12)mmol/L 对(4.12±1.31)mmol/L,P=0.007]、低密度脂蛋白[(2.92±0.84)mmol/L 对(1.99±0.84)mmol/L 对(2.30±1.08)mmol/L,P＜0.001]及肌酐[94(71,127)µmol/L 对 72(62,188)μmol/L 对 66(54,75)µmol/L,P＜0.001]和肾小球滤过率[(77±35)ml/min 对(88±27)ml/min 对(95±21)ml/min,P=0.042]差异存在统计学意义.对患者发病时严重程度、出院时状态及发病后90 d的随访结果进行比较,与外科手术组和介入手术组相比,未手术组患者的神经功能缺损更严重[美国国立卫生院卒中量表评分:9(3,16)分对3(1,9)分对3(1,7)分,P=0.006],出院时独立行走的比例更低[42.9％(9/21)对 77.6％(38/49)对 79.5％(35/44),P=0.004],发病后90 d的良好预后比例为47.6％(10/21),低于外科手术组(73.5％,36/49)或介入手术组(81.8％,36/44)患者(P=0.016).结论 外科手术和介入手术组患者发生的院内卒中症状相对较轻.未手术但发生院内卒中的往往为高危患者,如合并心功能不全、肾功能不全、血脂控制不理想,此类患者需要更为密切的关注,以尽可能降低其卒中风险.
Abstract
Objective To analyze the characteristics of patients hospitalized with cardiovascular disease and suffering in-hospital stroke.Methods This was a cross-sectional study.Patients with in-hospital stroke who were admitted to Fuwai hospital due to cardiovascular disease from January 2023 to September 2023 and underwent neurological consultation were collected.They were divided into non-surgery group,surgery group and interventional group.Baseline data,stroke severity and outcome of these patients were analyzed and compared.Results One hundred and fourteen patients were included in this study,78 of whom were male,accounting for 68.4％,and their age was(62±12)years.There were 21 cases without surgery,49 cases with surgery,and 44 cases with interventional therapy.Comparing the patients in the non-surgery group vs.the surgery group vs.the interventional group,there were statistical differences in some indicators,including age[(56±16)years vs.(61±11)years vs.(65±11)years,P=0.021],heart failure[57.1％(12/21)vs.10.2％(5/49)vs.2.3％(1/44),P＜0.001],systolic blood pressure[(112±18)mmHg vs.(125±20)mmHg vs.(129±17)mmHg,P=0.004],left ventricular end-diastolic diameter[(61±12)mm vs.(49±7)mm vs.(50±7)mm,P＜0.001],left ventricular ejection fraction(39％±15％vs.58％±10％vs.60％±9％,P＜0.001),total cholesterol[(4.69±1.15)mmol/L vs.(3.65±1.12)mmol/L vs.(4.12±1.31)mmol/L,P=0.007],low-density lipoprotein[(2.92±0.84)mmol/L vs.(1.99±0.84)mmol/L vs.(2.30±1.08)mmol/L,P＜0.001],creatinine[94(71,127)μmol/L vs.72(62,88)μmol/L vs.66(54,75)μmol/L,P＜0.001],and glomerular filtration rate[(77±35)ml/min vs.(88±27)ml/min vs.(95±21)ml/min,P=0.042].Comparing the patient's severity at onset,status at discharge,and follow-up results 90 days after onset,patients in the non-surgery group had more severe neurological deficits[9(3,16)vs.3(1,9)vs.3(1,7),P=0.006],the lower proportion of walking independently at discharge[42.9％(9/21)vs.77.6％(38/49)vs.79.5％(35/44),P=0.004],and the good prognosis 90 days after onset was 47.6％(10/21),which was lower than that in the surgical group(73.5％,36/49)or interventional surgery group(81.8％,36/44)patients(P=0.016).Conclusion Surgical and interventional procedures are relatively safe,and in-hospital stroke symptoms are mild.Patients who suffered in-hospital stroke without surgery are often high-risk patients,such as those with cardiac insufficiency,renal insufficiency,and unsatisfactory blood lipid control.Such patients require closer attention to minimize the risk of stroke.
基金项目
国家高水平医院临床科研基金(2022-GSP-TS-4)
NETL
NSTL
万方数据