2012～2016年基层医院脑卒中患者诊疗现状调查
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摘要
目的探讨基层医院脑卒中患者诊疗现状,以此为降低基层医疗负担提供依据。方法选取医院诊治的新发脑梗死、短暂性脑缺血发作及脑出血患者。通过回顾性分析其基线资料以及治疗情况等,统计神经功能缺损程度以及日常生活自理能力。结果共统计1128例脑卒中患者资料,其中脑梗死827例,短暂性脑缺血发作(TIA)患者72例,脑出血229例,单中心同期缺血性脑卒中发病率远高于脑出血(79.7%VS20.3%)。脑出血患者年龄更轻(64.57VS72.24,P<0.05),男性比例更高(57.6%VS49.4%,P=0.026),饮酒占比高(23.6%VS13.1%,P<0.05)。脑出血患者发病至入院时间更短;基线血压更高(180.5/99.5VS154.9/85.9mmHg,P<0.05),基线血糖值也显著高于缺血组(7.0VS6.4mmol/L,P<0.05)。缺血性卒中患者糖尿病患病率更高(18.5%VS6.6%,P<0.05),基线血尿酸、纤维蛋白原水平显著增高(P<0.05),但高密度脂蛋白明显低于脑出血组(P=0.001);入院时基线NIHSS评分更低(3.0VS10.0,P<0.05),3个月时神经功能预后较脑出血更好(mRS 1VS3,P<0.05);住院费用明显低于脑出血组,且住院周期更短(P<0.05)。结论本中心近5年收治的脑卒中主要为缺血性脑卒中,占近4/5,自发性脑出血病例较少1/5。本组脑卒中患者常见的危险因素为高血压、糖尿病、脂代谢紊乱及慢性房颤等。
Objective To explore the current situation of diagnosis and treatment of stroke patients in grass-roots hospitals, so as to provide evidence for reducing the burden of primary medical care. Methods Patients with newly diagnosed cerebral infarction, transient ischemic attack and intracerebral hemorrhage were selected. By retrospective analysis of baseline data and treatment, the degree of neurological deficits and daily living ability were statistically analyzed. Results A total of 1128 stroke patients were analyzed, including 827 cerebral infarction, 72 transient ischemic attack (TIA) and 229 cerebral hemorrhage. The incidence of ischemic stroke in single center was much higher than that in cerebral hemorrhage (79.7%VS20.3%). Patients with cerebral hemorrhage were younger (64.57 VS 72.24, P<0.05). The male ratio was higher (57.6%VS49.4%, P=0.026), and drinking accounted for a high proportion (23.6%VS13.1%, P<0.05). Patients with cerebral hemorrhage had shorter onset to admission, higher baseline blood pressure (180.5/99.5 VS 154.9/85.9 mmHg, P<0.05), and higher baseline blood glucose (7.0 VS 6.4 mmol/L, P<0.05). The prevalence of diabetes mellitus was higher in ischemic stroke patients (18.5% VS 6.6%, P<0.05), and the baseline levels of uric acid and fibrinogen were significantly higher (P<0.05). However, HDL was significantly lower than that in ICH group (P=0.001), baseline NIHSS score was lower at admission (3.0 VS 10.0, P<0.05), and neurological prognosis was better at 3 months (mRS 1 VS 3, P<0.05). The cost of hospitalization was significantly lower than that of cerebral hemorrhage group, and the length of hospital stay was shorter (P<0.05). Conclusion In the past five years, ischemic stroke is the main stroke in our center, accounting for nearly 4/5, and spontaneous cerebral hemorrhage is rare 1/5. Hypertension, diabetes, dyslipidemia and chronic atrial fibrillation were the common risk factors for stroke.
Objective To explore the current situation of diagnosis and treatment of stroke patients in grass-roots hospitals, so as to provide evidence for reducing the burden of primary medical care. Methods Patients with newly diagnosed cerebral infarction, transient ischemic attack and intracerebral hemorrhage were selected. By retrospective analysis of baseline data and treatment, the degree of neurological deficits and daily living ability were statistically analyzed. Results A total of 1128 stroke patients were analyzed, including 827 cerebral infarction, 72 transient ischemic attack (TIA) and 229 cerebral hemorrhage. The incidence of ischemic stroke in single center was much higher than that in cerebral hemorrhage (79.7%VS20.3%). Patients with cerebral hemorrhage were younger (64.57 VS 72.24, P<0.05). The male ratio was higher (57.6%VS49.4%, P=0.026), and drinking accounted for a high proportion (23.6%VS13.1%, P<0.05). Patients with cerebral hemorrhage had shorter onset to admission, higher baseline blood pressure (180.5/99.5 VS 154.9/85.9 mmHg, P<0.05), and higher baseline blood glucose (7.0 VS 6.4 mmol/L, P<0.05). The prevalence of diabetes mellitus was higher in ischemic stroke patients (18.5% VS 6.6%, P<0.05), and the baseline levels of uric acid and fibrinogen were significantly higher (P<0.05). However, HDL was significantly lower than that in ICH group (P=0.001), baseline NIHSS score was lower at admission (3.0 VS 10.0, P<0.05), and neurological prognosis was better at 3 months (mRS 1 VS 3, P<0.05). The cost of hospitalization was significantly lower than that of cerebral hemorrhage group, and the length of hospital stay was shorter (P<0.05). Conclusion In the past five years, ischemic stroke is the main stroke in our center, accounting for nearly 4/5, and spontaneous cerebral hemorrhage is rare 1/5. Hypertension, diabetes, dyslipidemia and chronic atrial fibrillation were the common risk factors for stroke.
引文
[1]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2015》概要[J].中国循环杂志,2016,31(31):624-632.
[2]中华医学会神经病学分会.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南(2010)[J].中华神经科杂志,2015,3(4):68-74.
[3]Yitshak SM,Novack V,Ifergane G,et al.Air Pollution and Ischemic Stroke Among Young Adults[J].Stroke,2015,46(12):3348-3353.
[4]中华医学会神经病学分会.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[5]杨期东,周艳宏,刘运海,等.长沙社区人群脑卒中患者发病的监测研究[J].中华医学杂志,2003,83(4):302-305.
[6]刘悦,卢明,莫创骑,等.早期高压氧治疗对脑出血血肿清除术后脑水肿及神经功能的影响[J].中国实用神经疾病杂志,2016,19(10):37-38.
[7]中华医学会神经病学分会.中国脑血管病一级预防指南2015[J].中华神经科杂志,2015,48(8):629-643.
[8]吕祥龙,李婧.短暂性脑缺血发作后缺血性脑卒中的危险因素[J].临床神经病学杂志,2017,30(4):271-274.
[9]申坤阳.辛伐他汀治疗急性缺血性脑卒中效果探讨[J].基层医学论坛,2016,20(26):3643-3644..
[10]朱祖建.阿司匹林联合氯吡格雷治疗进展性脑卒中的疗效及其机制研究[J].基层医学论坛,2016,20(27):3780-3781.
[11]徐洁,谭盛.缺血性脑卒中及短暂性脑缺血发作患者二级预防用药依从性的现状研究[J].实用医学杂志,2016,32(13):2095-2098.
[12]中华医学会神经病学分会.急性缺血性脑卒中早期血管内介入治疗流程与规范专家共识[J].中华神经科杂志,2017,50(3):172-177.
[13]储蓓林,刘丕,陈意东,等.上海市属养老机构阿司匹林预防心脑血管疾病患者应用现状调查[J].中国民康医学,2016,28(4):84-87.
[14]朱英标,官常荣,汤亚男,等.肢体缺血预处理在非心源性缺血性脑卒中患者二级预防中临床应用研究[J].中华全科医学,2016,14(12):2045-2048.
[15]刘黔云,燕飞,张云云.缺血性脑卒中病人Essen评分复发风险分层分析临床特点及近期预后[J].中西医结合心脑血管病杂志,2016,14(13):1461-1465.
[2]中华医学会神经病学分会.中国缺血性脑卒中和短暂性脑缺血发作二级预防指南(2010)[J].中华神经科杂志,2015,3(4):68-74.
[3]Yitshak SM,Novack V,Ifergane G,et al.Air Pollution and Ischemic Stroke Among Young Adults[J].Stroke,2015,46(12):3348-3353.
[4]中华医学会神经病学分会.中国脑出血诊治指南(2014)[J].中华神经科杂志,2015,48(6):435-444.
[5]杨期东,周艳宏,刘运海,等.长沙社区人群脑卒中患者发病的监测研究[J].中华医学杂志,2003,83(4):302-305.
[6]刘悦,卢明,莫创骑,等.早期高压氧治疗对脑出血血肿清除术后脑水肿及神经功能的影响[J].中国实用神经疾病杂志,2016,19(10):37-38.
[7]中华医学会神经病学分会.中国脑血管病一级预防指南2015[J].中华神经科杂志,2015,48(8):629-643.
[8]吕祥龙,李婧.短暂性脑缺血发作后缺血性脑卒中的危险因素[J].临床神经病学杂志,2017,30(4):271-274.
[9]申坤阳.辛伐他汀治疗急性缺血性脑卒中效果探讨[J].基层医学论坛,2016,20(26):3643-3644..
[10]朱祖建.阿司匹林联合氯吡格雷治疗进展性脑卒中的疗效及其机制研究[J].基层医学论坛,2016,20(27):3780-3781.
[11]徐洁,谭盛.缺血性脑卒中及短暂性脑缺血发作患者二级预防用药依从性的现状研究[J].实用医学杂志,2016,32(13):2095-2098.
[12]中华医学会神经病学分会.急性缺血性脑卒中早期血管内介入治疗流程与规范专家共识[J].中华神经科杂志,2017,50(3):172-177.
[13]储蓓林,刘丕,陈意东,等.上海市属养老机构阿司匹林预防心脑血管疾病患者应用现状调查[J].中国民康医学,2016,28(4):84-87.
[14]朱英标,官常荣,汤亚男,等.肢体缺血预处理在非心源性缺血性脑卒中患者二级预防中临床应用研究[J].中华全科医学,2016,14(12):2045-2048.
[15]刘黔云,燕飞,张云云.缺血性脑卒中病人Essen评分复发风险分层分析临床特点及近期预后[J].中西医结合心脑血管病杂志,2016,14(13):1461-1465.