院内卒中复发和TIA发作后卒中的相关危险因素及中医证型研究  

Risk Factors Associated with Stroke in Hospital after Recurrent Stroke and TIA and TCM Syndromes

作　　者：谢步霓[1] 王谨敏[1] 廖远生[1] 林菊珊[1] 吴成翰[1] XIE Bu-ni;WANG Jin-ming;LIAO Yuan-sheng;LIN Ju-shan;WU Cheng-han(Department of Encephalopathy,the Second Affiliated Hospital of Fujian University of TCM,Fuzhou,Fujian Province,350003 China)

机构地区：[1]福建中医药大学附属第二人民医院脑病科,福建福州350003

出　　处：《中外医疗》2017年第36期8-11,共4页China & Foreign Medical Treatment

基　　金：福建省中医药科研项目课题(2017FJZYLC209)

摘　　要：目的探讨住院期间急性期脑梗死及TIA(Transient ischaemic attack)患者早期缺血性卒中复发的危险因素及中医证候特征。方法该研究对2014年1月—2016年12月间福建中医药大学附属第二人民医院神经科的所有急性缺血性卒中或TIA患者进行了回顾性分析。搜集483例脑梗死急性期及TIA患者的个人特征、既往病史、临床特征、治疗方法、实验室数据及中医证候等临床信息,比较复发与未复发患者脑梗死危险因素及中医证候要素的差异。结果该研究包括483例患者,22例患者(4.6%)出现了卒中复发,中位复发时间为入院后3 d,四分位距2~5。多变量Logistics回归分析结果显示既往TIA病史[比值比(odds ratio,OR)4.22,95%可信区间(confidence interval CI)1.42~12.58;P=0.010],合并感染(OR 4.72,95%CI:1.41~15.82;P=0.012)为卒中复发的独立危险因素(P<0.05)。复发脑梗死组内风证较未复发组多见(55.0%vs 26.7%,P<0.05)。结论接受二级预防管理的患者院内卒中复发率较低。有TIA病史,合并呼吸道、泌尿系感染的患者,中医证候含内风证其卒中复发风险较高,在临床实践中应予以重视。Objective This paper tries to investigate the risk factors of early ischemic stroke recurrence in patients with acute cerebral infarction and TIA(Transient ischaemic attack)during hospitalization and the TCM syndrome characteristics.Methods The writer retrospectively analyzed all acute ischemic stroke or TIA patients in the Department of Neurology in this hospital from January 2014 to December 2016.483 cases of acute cerebral infarction and TIA patients with personal characteristics,past medical history,clinical features,treatment methods,laboratory data and TCM syndromes and other clinical information,recurrent and non-recurrent patients with cerebral infarction risk factors and TCM syndrome elements difference.Results Of 483 patients 22(4.6%)with cerebral infarction or TIA had recurred in hospital.Median recurrent time was 3 days after admission(interquartile range 2~5).Logistic regression analysis showed that past medical history of TIA(odds ratio(OR):4.22,95%confidence interva(CI:1.42~12.58;P=0.010),combination of urinary tract or pulmonary infection(OR 4.72,95%CI:1.41~15.82;P=0.012)were the independent risk factors for recurrence(P<0.05).Patients with wind syndrome of recurrent cerebral infarction were more than that of non-recurrent(55.0%vs 26.7%,P<0.05).Conclusion Patients receiving secondary prevention management had a lower rate of recurrent stroke within the hospital.TIA history,with respiratory tract,urinary tract infection in patients with TCM syndrome endogenous wind syndrome has a higher risk of recurrent stroke,which should be taken seriously in clinical practice.

关 键 词：脑梗死 短暂性脑缺血发作(TIA) 复发 危险因素 中医证候 

分 类 号：R5[医药卫生—内科学]