缺血性脑卒中后谵妄的临床及影像学相关因素研究  

Clinical and imaging correlated analysis of delirium in patients with acute ischemic stroke

作　　者：屈剑锋[1] 陈仰昆[1] 罗根培[1] 钟伙花 尹翰鹏 肖卫民[1] 

机构地区：[1]东莞市人民医院神经内科,广东东莞523000

出　　处：《广东医学》2018年第2期212-215,共4页Guangdong Medical Journal

基　　金：东莞市科技计划医疗卫生类科研一般项目(编号:201510515000391)

摘　　要：目的探讨在缺血性脑卒中急性期,合并谵妄的临床及影像学相关因素。方法纳入251例急性缺血性脑卒中患者,在入院后1~3 d内及5~7 d内进行意识错乱评估方法(CAM)量表评定。脑卒中后谵妄(PSD)依据CAM的标准进行诊断。比较谵妄及非谵妄组间的临床及颅脑MRI变量的差异,并使用logistic回归方程探讨PSD的影响因素。结果 34例(13.5%)患者诊断为PSD。与非谵妄患者相比,PSD患者的年龄(岁)较大[(69.5±16.7)岁vs(59.9±14.1)岁,P<0.001],入院的NIHSS评分较高[9(5~15)分vs 4(1~7)分,P<0.001]。PSD者既往卒中史的比例以及感染发生率较高(35.3%vs 13.8%,P=0.002;38.2%vs 9.2%,P<0.001)。缺血性脑卒中后谵妄更常发生在大动脉病变型的脑梗死患者(P=0.005)。两组脑梗死体积[11.03(4.065~71.5)vs 1.67(0.75~7.62),P<0.001]、内侧颞叶萎缩(MTLA)[2(0~5)vs 0(0~2),P<0.001]、左侧皮层脑梗死患者的比例(47.1%vs 24.0%,P=0.005)差异有统计学意义。多因素logistic回归分析显示,左侧皮层梗死、MTLA、入院时NIHSS评分及入院后合并感染为PSD的独立相关因素。结论谵妄状态在急性期脑梗死早期发生率较高。左侧皮层梗死、MTLA、入院时NIHSS评分及入院后合并感染为PSD的独立相关因素,提示PSD可能是本次卒中与既往脑部损害共同作用的结果。Objective To investigate the clinical and MRI indicators of post -stroke delirium （PSD） in patients at acute phase after isehemic stroke. Methods A total of 251 patients with acute isehemie stroke participated in this study. All participants were screened for delirium during the first week after admission. We diagnosed delirium with the Confusion Assessment Method （CAM）. Clinical and MRI variables were compared between the patient with PSD and without PSD. Logistic regressions were performed to find the risk factors of PSD. Results PSD was revealed in 34 （ 15.7% ） patients. Comparing with non -PSD group, patients with PSD had significantly elder age （69. 5 ±16. 7 vs. 59. 9 ± 14. 1, P 〈 0. 001 ） , higher NIHSS score at admission [ 9 （ 5 - 15 ） vs. 4 （ 1 - 7 ） , P 〈 0. 001 ] , morbidities of pre - stroke history （35.3% vs. 13.8%, P =0. 002） and infection complications （38.2% vs. 9.2%, P 〈 0. 001 ）. PSD was significantly more common in the large - artery atheroselerosis （LAA） form ischemic stroke （P = 0. 005 ）. There were significant differences in the volume of infarction [ 11.03（4. 065 -71.5） vs. 1.67（0. 75 -7.62）, P 〈0. 001 ], MTLA [2（0 -5） vs. 0（0 -2） , P 〈0. 001 ] and left side cortical infarctions （47. 1% vs. 24. 0% , P =0. 005） between the PSD and non - PSD groups. Logistic regression analysis showed that left - side cortical infarction, MTLA, the NIHSS score on admission and infectious complications were significantly correlated with PSD. Conclusion PSD is common in acute phase after ischemic stroke. Left - side cortical infarction, the degrees of MTLA, severity of neurological deficits, and infectious complications are the major determinants of PSD, suggesting that PSD may be associated with both the index stroke and preexisting brain abnormalities.

关 键 词：脑梗死:谵妄 颅脑核磁共振 

分 类 号：R743.3[医药卫生—神经病学与精神病学]