缺血性脑卒中早期神经功能恶化的影响因素及参麦注射液对其疗效的研究被引量：35

Risk factors related to early neurological deterioration in patients with ischemic stroke and curative effect of Shenmai injection

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摘要目的探讨影响缺血性脑卒中发生早期神经功能恶化（END）的相关因素以及参麦注射液对其的疗效。方法回顾性分析长治医学院附属和济医院神经康复科自2008年6月至2012年6月收治的120例缺血性脑卒中患者的临床资料，其中发生END34例（应用参麦注射液13例1，未发生END86例（应用参麦注射液57例1。采用单因素和多因素Logistic回归分析方法，分析年龄、性别、体质量、吸烟、饮酒、既往病史（高血压、糖尿病、高脂血症、心房颤动、冠心病）、颈动脉狭窄、粥样硬化斑块、美国国立卫生研究院卒中量表（NIHSS）评分、参麦注射液的使用以及白细胞计数、C反应蛋白、空腹血糖、血清总胆固醇、低密度脂蛋白胆固醇、三酰甘油、高密度脂蛋白胆固醇、凝血酶原时间、部分凝血酶原时间、纤维蛋白原、D．二聚体等因素与END发生的关系。治疗后第90天使用Barthel指数评定患者神经功能变化情况及日常生活能力。结果单因素分析显示2组患者间高血压比例、糖尿病比例、高脂血症比例、心房颤动比例、白细胞计数、颈动脉狭窄≥50％比例、粥样硬化斑块稳定比例、D-二聚体、参麦注射液使用比例及NHSS评分比较差异均有统计学意义（P〈0．05）。多因素Logistic逐步回归分析筛选出最终的危险因素为高血压病（OR=1．385，95％CI：0．286～1．547．P=0．048）、糖尿病（OR=3．683．95％CI：1．268～4．378．P=0．012）、心房颤动（OR=3．534，95％CI：1．483-4．685，P=0．013）、颈动脉狭窄≥50％（OR=3．869，95％CI：1．154-5．998，P=0．003）、参麦注射液的使用（0R=2．785，95％CI：0．882～3．386，P=0．023）和NIHSS评分（OR=2．439，95％CI：0．675-3．986，P=0．015）。治疗后第90天时END组和非END组中应用参麦注射液患者的Barthel指数均明显高于未应用者，差异均有统计学意义（P〈0．05）。结论急性缺血性脑卒中发生END相当常见且预后较差，入院时有高血压、糖尿病、心房颤动及颈动脉狭窄≥50％、高NIHSS评分综合影响着END的发生，及时识别高危患者并给予积极参麦注射液治疗有助于改善预后。 Objective To explore the risk factors related to early neurological deterioration （END） in patients with ischemic stroke and the curative effect of Shenmai injection. Methods The clinical data of 120 patients with ischemic stroke treated in our hospital from June 2008 to June 2012, including 34 with END （13 receiving Shengmai injection） and 86 without END （57 receiving Shenmai injection）, were analyzed retrospectively. Single factor analysis and multi-factor Logistic regression analysis were employed to analyze the relations of END with age, gender, body weight, smoking, drinking, disease history, hypertension, carotid artery stenosis, arteriosclerosis plaque, National Institutes of Health Stroke Scale （NIHSS） scores, use of Shenmai, levels of leukocytes, C-reaction protein, fasting blood-glucose, total cholesterol, low-density lipoprotein cholesterol, triacylglycerol, high-density lipoprotein cholesterol, fibrinogen and D-dimer, prothrombin time and partial prothrombin time. Results Single factor analysis showed that the factors related to prognosis of patients with END included hypertension, diabetes, white blood cell count, hyperlipoidemia, atrial fibrillation, carotid artery stenosis≥ 50%, arteriosclerosis plaque, D-dimer and C-reaction protein levels, prothrombin time use of Shenmai and NIHSS scores. Multi-factor Logistic regression analysis indicated that hypertension （OR= 1.385, 95%CI： 0.286-1.547, P=0.048）, diabetes （OR=3.683, 95%CI： 1.268-4.378, P=0.012）, atrial fibrillation （OR=3.534, 95%CI： 1.483-4.685, P=0.013）, carotid artery stenosis≥ 50% （OR=3.869, 95%CI： 1.154-5.998, P=0.003）, use of Shenmai （OR= 2.785, 95%CI： 0.882-3.386, P=0.023） and NIHSS scores （OR=2.439, 95%CI： 0.675-3.986, P=0.015） could affect the incidence of END. Barthel index in patients used Shenmai was significantly higher than that in patients not used in both groups （P〈0.05）. Conclusions Neurological deterioration after acute ischemic stroke is a frequent phenomenon, which causes poor prognosis. Admission hyperglycemia, diabetes mellitus, atrial fibrillation, carotid artery stenosis ≥50% and high NIHSS scores can predict early neurological deterioration. Identifying the patients with high risk and giving Shenmai injection therapy may improve the outcome of patients with ischemic stroke.

作者靳贵生李伟张建斌

机构地区长治医学院附属和济医院药剂科长治医学院附属和济医院神经康复科

出处《中华神经医学杂志》 CAS CSCD 北大核心 2013年第9期914-918,共5页 Chinese Journal of Neuromedicine

关键词缺血性脑卒中早期神经功能恶化参麦注射液影响因素 Ischemic stroke Early neurological deterioration Shenmai injection Influencing factors

分类号 R743.3 [医药卫生—神经病学与精神病学]

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