1999年与2009年住院急性脑梗死患者的对比研究
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摘要
目的:急性脑梗死是严重威胁人类生命与健康的疾病之一,严重影响着人们生活质量。该研究探讨急性脑梗死危险因素、住院期间医疗观察指标以及住院期间治疗,为急性脑梗死的预防及治疗提供依据。方法:采用回顾性调查方法分析1999年与2009年在新疆医科大学第一附属医院住院的急性脑梗死患者的资料,运用SPSS13.0统计软件包进行统计分析,构成比比较采用χ2检验,P<0.05有统计学意义。结果:(1)急性脑梗死1999年与2009年年龄构成比无统计学差异(P>0.05);两组性别构成比有统计学差异(P<0.05)。(2)1999年与2009年急性脑梗死患者民族构成比无统计学差异(P>0.05)。(3)1999年与2009年急性脑梗死患者既往高血压病、糖尿病、心脏病、饮酒史构成比有统计学差异(P<0.05),既往脑卒中和吸烟史无统计学差异(P>0.05)。(4)2009年检测纤维蛋白原、空腹血糖、血脂、肝功、肾功、心电图、胸片、动态血压、动态心电图、心脏超声、颈部超声、TCD、MRI、DSA、免疫、腹部超声患者构成比高于1999年(P<0.05)。1999年未检测D-二聚体、CRP、同型半胱氨酸、CTA、MRA。2009年未检测血粘度、血沉。(5)2009年使用阿司匹林、预防应激性溃疡、预防感染、抗凝、脱水降颅压、降血压、调脂、降血糖患者构成比高于1999年(P<0.05)。结论:(1)急性脑梗死主要危险因素为血浆纤维蛋白原增高、高血压病、血脂异常、吸烟、血糖增高、血常规异常、饮酒史等。2009年对于危险因素的筛查较1999年有所提高。(2)2009年医疗观察检测指标较1999年增多,但观察检测指标尚存在部分缺陷,应加强CRP、同型半胱氨酸、颈部血管超声的检测,注意动脉粥样硬化的筛查。(3)2009年阿司匹林片、氯吡格雷片的使用、预防应激性溃疡、预防感染等并发症的治疗以及早期康复的治疗较1999年明显提高,更有助于患者生活质量的改善。
Objective:Acute cerebral infarction is a serious threat to human life and health of one of the diseases, a serious impact on quality of life. The study of risk factors for acute cerebral infarction during hospitalization period of medical observation and inpatient treatment targets for the prevention of acute cerebral infarction and therapy. Methods: Retrospective analysis of survey methodology in 1999 and 2009, the First Affiliated Hospital of Xinjiang Medical University, acute cerebral infarction data, using statistical package for statistical analysis SPSS 13.0, proportion compared using X2 test, P<0.05 statistically significant. Results:(1) acute cerebral infarction in 1999 and 2009 was no significant difference in age composition ratio (P>0.05); the two groups weresignificantly different than the gender composition (P<0.05). (2) 1999 and 2009 the ethnic composition of patients with acute cerebral infarction than those without significant difference (P> 0.05). (3) 2009,1999 and previous hypertension in patients with acute cerebral infarction, diabetes, heart disease, history of drinking constitutes a significant difference compared (P <0.05), previous stroke, and smoking history was no significant difference (P>0.05). (4) 2009 Fibrinogen, fasting glucose, lipids, liver function, renal function, electrocardiogram, chest radiograph, blood pressure, electrocardiogram, cardiac ultrasound, neck ultrasound, TCD, MRI, DSA, immunity, patients with abdominal ultrasound constitute ratio higher than in 1999 (P<0.05). Not detected in 1999, D-dimer, CRP, homocysteine, CTA, MRA. Not detected in 2009 blood viscosity, erythrocyte sedimentation rate. (5) 2009, use of aspirin to prevent stress ulcers, prevention of infection, coagulation, dehydration reduce intracranial pressure, blood pressure, lipid, lower blood sugar in patients with proportions higher than in 1999 (P<0.05). Conclusions:(1) the major risk factors for acute cerebral infarction plasma fibrinogen increased, hypertension, dyslipidemia, smoking, blood sugar, blood abnormalities, history of drinking and so on.2009, screening for risk factors has increased compared to 1999. (2) detection of indicators of medical observation in 2009 compared to 1999 increased, but there are still part of the observed defect detection index, should strengthen the CRP, homocysteine, and neck vascular ultrasound testing, attention atherosclerosis screening. (3) 2009, aspirin, clopidogrel tablets use of stress ulcer prevention, prevention of infection and other complications of treatment and early rehabilitation therapy significantly improved over 1999, but also help the quality of life of patients improvement.
引文
[1]吴兆苏,姚崇华,赵冬.我国人群脑卒中发病率、死亡率的流行病学研究[J].中华流行病学杂志,2003,24(3):236-239
    [2]各类血管疾病诊断要点[J],中华神经科杂志,1996,29(6):379
    [3]冯仁丰.实用医学检验学[M].上海:上海科学技术出版社,1996,368-388
    [4]陈兴洲.脑血管疾病研究现状与前景,MI.上海:第二军医大学出版社,2001,180-181.
    [5]饶明俐.《中国脑血管病防治指南》摘要(一)[J].中风与神经疾病杂志,2005,22:389
    [6]贾建平.神经病学.第6版.北京:人民卫生出版社,2008.6:176
    [7]Beg M, Nizami A, Singhal KC, et al. Role of serum fibrinogen in Patients of ischemic cerebrovascular disease[J]. NePal Med Coll J,2007,9(2):88-92
    [8]Feigin VL, Lawes CM, Bennett DA, et al. Worldwide stroke incidence and early case fatality reported in 56 Population-based studies:a systematic review[J]. LancetNeuro, 12009,8(4):355-369
    [9]Marini C, Carolei A, Roterts RS, et al. Focal Cerebral is chemia in young adults:a collaborative Case-control study. The National Research Council Study Group. Neuroepi demiology,1993,12(2):70-81
    [10]Kittner SJ, Stern BJ, Wozniak M, et al. Cerebral infarction in young adults[J]. Neurology,1998,50:890-894
    [11]滕跃华,姜翠琴.89例青年脑梗死危险因素分析[J].医学信息.2010.23(2):359
    [12]王文化,赵冬,吴贵贤,等.北京市1984-1999年人群脑卒中发病率变化趋势分析[J].中华流行病学杂志,2001,22:269-272
    [13]Bogousslavssky, Pierrer schemie stroke in patients under age 45[J]. Neurol Clin,1992, 10(1):113-124
    [14]杨期东,周艳红,王文志,等.中国三个城市社区人群脑卒中死亡及其类型分布特征.中华老年心脑血管病杂志,2003,5:39-42
    [15]李世绰,程学铭,王文志,等.神经系统疾病流行病学.北京:人民卫生出版社,2000.72-87
    [16]Naess, Nyland, Thomassenl, et al. Ineidenee and shortte rmoutcome of cerebra linfarction in young adults in western Norway[J]. Stroke,2002,33(8):2105-2108
    [17]Lidegaardo, Soem, Ersen MV. Cerebral thromboembolism among young women and men in Denmark1977-1982[J]. Stroke,1986,17:670-675
    [18]Nikodemowicz M. The effects of smoking on eardiovaseular system[J]. Przegllek, 2007,64(14):42-44
    [19]Zheng LQ, Sun ZQ, et al. Pulse pressure and Mean Aiterial Pressurein Relation to Ischemie Stroke Among Patients With Uneontrolled By Pertension in Rural Aieas of China[J]. Stroke,2008,39:1932-1937
    [20]Bravata DM, Wells CK, Kernan WN, et al. Assoeiation between Impaire dinsulinsen sitivity and stroke[J]. Neuroe Pidemiology,2005,25:69-74
    [21]Jood K, LAdenval C, Rosengren A, et al. Family History in Ischemic Stroke Before 70 Years of Age. The Sahlgrenska Academy Study on Isehemie, Stroke[J]. Stroke,2005, 36:1383
    [22]Kurth T, Moore SC, Gaziano JM, et al. Healthy life style and the rise stroke in women[J]. AichIntem Med, Jul2006,166:1403-1409
    [23]Howardq V, Agenknecht LE, Cai JW, et al. Cigarette smoking an do the factors for Silent cerebralin farction in the general Population[J]. Stroke,1998,29:913-917
    [24]Wanamethee SQ, Shaper G, Patterns of Aleohol In take and Risk of Stroke[J]. Stroke, 1999,25:687-689
    [25]沈顺姬,张淑琴.降纤酶治疗缺血性脑血管病的疗效观察[J].中风与神经疾病杂志,2002,12:368
    [26]缺血性卒中/短暂性脑缺血发作二级预防中抗血小板药物规范化应用专家共识组.缺血性卒中/短暂性脑缺血发作二级预防中抗血小板药物规范化应用专家共识[J].中华内科杂志,2009,48:256-258
    [27]史光云.青年人长期酗酒致急性脑梗死21例临床分析与体会[J].中国健康文摘.2010.9(24):113-114
    [28]章军建,阮旭中,张苏明,等.大鼠局灶性脑缺血再灌流半暗带神经细胞坏死与凋亡的动态变化[J].中华老年医学.1999.3(18):112
    [29]Nguyen-Ho P, Lakkis NM. Platelet glycoprotein Ⅱb/Ⅲa receptor antagonists and coronary artery disease[J]. Curr Atherosclerrep,2001,3(2):139-148
    [30]Pieper CF, Rao KM, Currie MS, et al. Age functional status, and racial differences in Plasmad-dimer levels in community-dwelling elderly persons[J]. J Gerontola Biol sciMed Sci,2000,55(11):649-657
    [31]Dinapolin M, PaPa F, Bocola V. Prognostic influence of increased C-reactiveProtein and fibrinogen levels in ischemic stroke[J]. Stroke,2001,32(1):133-138
    [32]王俊珺,袁肖征,施燕红等,纤维蛋白原血清水平与脑梗死临床研究,中华全科 医学,2010,8(8):993-994
    [33]Levy DE, Delzoppo GJ, Demaerschalk BM. Ancrod in Acute Ische-mic Stroke. Results of 500 subjects beginning treatment within 6hours of stroke onset in the ancrod stroke program[J]. Stroke,2009,40(12):3796-3803
    [34]谢静,陈齐鸣,屈洪党,等.降纤酶治疗急性进展型脑梗死疗效观察[J].实用全科医学,2007,5(3):217-218
    [35]孟庆森.低分子肝素治疗进展脑梗死疗效观察[J].实用全科医学,2005,3(1):36-37
    [36]他汀类药物防治缺血性卒中/短暂性脑缺血发作的专家共识组.他汀类药物防治缺血性卒中/短暂性脑缺血发作的专家共识(更新版)[J].中华内科杂志,2008,47:873-875
    [37]Amarenco P, Bogousslavsky J, Callahan A, et al. High-dose atorvastatin after stroke or transient ischemic attack[J]. N Engl J Med,2006,355(6):549-592.
    [38]郏淑珍.普伐他汀对脑梗死伴颈动脉粥样硬化患者血清超敏C反应蛋白和D-二聚体的影响[J].江西医药,2008,43(5):434-436
    [39]Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactiveprotein[J]. Nenglmed,2008,359(21):2195-2207
    [40]薛国芳.C-反应蛋白与脑卒中关系的研究进展[J].国际神经病学神经外科学杂志,2006,33(6):514-515
    [41]杨谦,郭生龙,陈岩等.普伐他汀干预青中年脑梗死患者颈动脉粥样硬化斑块及C-反应蛋白的变化[J].中国组织工程研究与临床康复,2007,11(8):1525-1528
    [42]Ridker PM, Rifai N, Pfeffer MA, et al. Long-term effects of pravastatin on plasma concentration of C-reactive protein[J]. The Cholesterol and Recurrent Events (CARE) Investigators. Circulation,1999,100(3):230-235
    [43]何忠芳,刘芳,翟所迪等,他汀类药物对脑梗死患者C-反应蛋白和颈动脉内中膜厚度影响的系统评价[J].中国循证医学杂志2009,9(8):873-879
    [44]郭佳,田金徽,杨克虎.他汀类药物预防卒中再发的系统评价[J].中国循证医学杂志,2009,9(5):565-569
    [45]Amarenco P, Labreuche J. Lipid management in the Prevention of stroke:review and updated meta-analysis of statins for stroke Pre-vention[J]. Lancet Neuro,12009,8: 453-463
    [46]Sarti C, Stegmayr B, Tolonen H, et al. Changes in mortality from stroke caused by changes in stroke event rates or case fatality?Results from the WHO MONICA Project[J]. Stroke,2003;34:1833-1841
    [47]World Health Organization. The World Health Report 2000. Geneva:WHO,2000;
    [48]Asian Acute Stroke Advisory Panel. Stroke epidemiological data of nine Asian countries[J]. J Med Assoc Thai,2000;83:1-7
    [49]White H, Boden-Albala B, Wang C, et al. Ischemic stroke subtype incidence amog whites, blacks, and Hispanics:the Northern Manhattan Study[J]. Circulation,2005; 111 (10):1327-1331
    [50]Schlager O, Exner M, et al. C-reactive protein predicts future cardiovascular events in patients with carotid stenosis[J]. Stroke.2007,38(4):1263-8
    [51]Amarenco P, Bogousslavsky J, Callahan A 3rd, et al. High-dose atorvastatin after stroke or transient ischemic attack[J]. N Engl JMed,2006,355(6):549-592
    [52]郏淑珍.普伐他汀对脑梗死伴颈动脉粥样硬化患者血清超敏C反应蛋白和D-二聚体的影响[J].江西医药,2008,43(5):434-436
    [53]Ridker PM, Danielson E, Fonseca FA, et al. Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein[J]. N Engl Med,2008,359(21): 2195-2207
    [54]薛国芳.C-反应蛋白与脑卒中关系的研究进展[J].国际神经病学神经外科学杂志,2006,33(6):514-515
    [55]杨谦,郭生龙,陈岩,等.普伐他汀干预青中年脑梗死患者颈动脉粥样硬化斑块及C-反应蛋白的变化.中国组织工程研究与临床康复[J],2007,11(8):1525-1528
    [56]何忠芳,刘芳,翟所迪等,他汀类药物对脑梗死患者C-反应蛋白和颈动脉内中膜厚度影响的系统评价[J].中国循证医学杂志2009,9(8):873-879
    [57]黄玲.脑梗死治疗进展[J].中国医学文摘.内科学,2009,4(4):619-621
    [58]Bamford J, Sandercock P, Dennis M, et al. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet,1991,337:1521-1526
    [59]Sturm JW, Dewey HM, Donnan GA, et al. Handicap after stroke:how does it relate to disability, perception of recovery, and stroke subtype?the north east melbourne stroke incidence study(NEMESIS). Stroke,2002,33:762-768
    [60]Evans A, Perez I, Yu G, et al. Should stroke subtype influence anticoagulation decisions to prevent recurrence in stroke patients with atrial fibrillation Stroke,2001, 32:2828-2832
    [1]杨光福.现代实用脑血管病学[M].北京:中国致公出版社,2001.7:105
    [2]贾建平.神经病学[M].第6版.北京:人民卫生出版社,2008.6:176
    [3]Wahlgren N, Ahmed N, Davalos A, et al. Thrombolysiswith altePlase for acute ischaemic stroke in the Safe ImPlementation ofThrombolysis in Stroke-Monitoring Study (SITS-MOST):an observational study[J]. Lancet,2007,369:275-282
    [4]王雪里红,曾红,樊琨,等.重组组织型纤溶酶原激活剂早期静脉溶栓对急性脑梗死的疗效[J].中华神经科杂志,2006,39(10):678-682
    [5]谭安雄,李金成,王玉银,等.重组组织型纤溶酶原激活剂治疗急性脑梗死的疗效评价[J].中国医药导报,2009,6(2):40-42
    [6]Niessen F, Hilger T, Hoehn M, et al. Thomboly-treatment of clotembolism in ratComParison ofintra-arterial and intravenous aPPlication of recombinant tissue Plasm inogen activator[J]. Stroke,2002,33 (12):2999-3005
    [7]严斌,杨建军,宋雪丹,等.重组组织型纤溶酶原激活剂动脉溶栓治疗急性脑梗死的疗效观察[J].现在实用医学,2009,21,5:455-456
    [8]杨辉.降纤酶治疗急性脑梗死的疗效观察[J].海南医学院学报,2009,15(7):740-741
    [9]贝为武,农智新.降纤酶治疗急性脑梗死的疗效及对血浆纤维蛋白原、D-二聚体水平的影响[J].山东医药,2009,49(31):58-59.
    [10]赵明辉,曾爱源,刘开详.降纤酶治疗急性脑梗死临床疗效及对纤维蛋白原、血液流变学、C-反应蛋白水平的影响[J].吉林医学,2009,30(21):2646-2647
    [11]杨翠展,张定华,张尚忠,等.急性期缺血性脑梗死溶栓和抗凝治疗[J].中国医学创新,2009,6(9):44
    [12]林贵军,胡世文,刘宗明,等.动脉内超选择性溶栓治疗急性缺血性脑梗死[J].中国脑血管病杂志,2004,1(7):303-305
    [13]刘艳辉.尿激酶静脉溶栓治疗早期脑梗塞的临床研究[J].中华中西医学杂志,2009,8(12):52-53
    [14]李飞,周瑾,刘均均.重组链激酶治疗脑梗死伴高粘血症20例疗效观察[J].上海 医药,2006,27(9):402-403
    [15]赵建华,马讯,林俊杰.低分子量肝素治疗急性脑梗死疗效的研究[J].中国脑血管病杂志,2004,1(6):252-254
    [16]张宗艳,王胜,王宏,等.急性脑梗塞患者血清高敏C—反应蛋白的临床意义及阿司匹林的影响[J].医药卫生,2009,38(5):183-184
    [17]樊云峰.奥扎格雷钠治疗急性脑梗死的临床疗效[J].临床医学,2010,30(3):50-51
    [18]赵晴,于挺敏,邬全英,等.奥扎格雷钠减低大鼠急性全脑缺血再灌注损伤后CasPase23表达及细胞凋亡的研究[J].中风与神经疾病杂志,2003,20(4):369
    [19]Toyoda K, FujiiK, Kamouchi M, et al. Free radical scavenger, edaravone, in stroke with internal carotid artery occlusion[J]. Neurol Sci,2004,221(1-2):11-17.
    [20]阳清伟.依达拉奉治疗急性脑梗塞的系统评价.中国循证医学志,2006,6(1):18-22
    [21]张月辉,詹成,林文.亚低温疗法治疗大面积脑梗死患者的疗效观察[J].实用全科医学,2008,6(3):266-267
    [22]吕风亚.亚低温对大面积脑梗死病人临床疗效及血清NSE、S-100蛋白的影响[J].神经疾病与精神卫生,2004,4(6):435-436
    [23]于秋红,张红霞,刘亚玲,等.单次9小时高压氧超早期治疗对大鼠脑梗死体积的影响[J].中国卒中杂志,2008,3(9):665
    [24]孙国兵,许康,周瑞,等.高压氧治疗急性脑梗死的临床观察.卒中与神经疾病[J],2009,16(6):356-357
    [25]胡小铭,汪杰,阮善平,等.面积脑梗死的手术治疗.浙江创伤外科[J],2007,12(6):496-497
    [26]韩松,周晓萍.急性大面积脑梗塞的外科治疗.临床神经外科[J],2008,5(2):108-109
    [27]Sun Y, Jin K, Peel A, et al. Neuroglob in Protecting the brain fromexPerimental stroke in vivo[J]. Proc Natl Acad Sci USA,2003,100(6):3497-3500.
    [28]Paul R, Zhang ZG, Eliceiri BP, et al. Src deficiency or blockade of Src activity in mice Provides cerebral Protection following stroke[J]. Nat Med,2001,7(2):222-227.
    [29]Asoh S, Ohsawa L, Mori T, et al. Protection against ischemic brain injury by Protein theraPeutics[J]. Proc Natl Acad Sci USA,2002,99(26):17107-17112
    [30]刘新峰.脑血管病介入治疗学[M].第1版.北京:人民卫生出版社,2006:5.

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