儿童动脉缺血性脑卒中的预后追踪研究  

A follow-up study on the prognosis of pediatric arterial ischemic stroke

作　　者：庞一琳[1] 武洁[1] 王龙[1] 张成晔[1] 赵光远[1] 霍枫[1] 王荃[1] Pang Yilin;Wu Jie;Wang Long;Zhang Chengye;Zhao Guangyuan;Huo Feng;Wang Quan(Department of Emergency,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院急诊内科,100045

出　　处：《中国小儿急救医学》2021年第12期1041-1046,共6页Chinese Pediatric Emergency Medicine

摘　　要：目的了解儿童动脉缺血性脑卒中(pediatric arterial ischemic stroke,PAIS)患者的预后情况。方法回顾性分析2015年7月至2020年4月于北京儿童医院急诊科就诊的1个月~18岁PAIS患儿的临床资料,通过电话随访的方式,采用改良Rankin量表(modified Rankin scale,MRS)对其进行评分,评估PAIS患儿的神经功能恢复情况、病死率及复发情况,分析PAIS致死、致残的危险因素。结果共纳入101例PAIS患儿,随访期内32.7%(33/101)的患儿无明显神经系统后遗症(MRS 0分),24.8%(25/101)呈不影响日常生活的轻微症状(MRS 1分),轻度残疾(MRS 2分)和中重度残疾(MRS 3~5分)分别为13.9%(14/101)和9.9%(10/101)。18.8%(19/101)的患儿随访期内死亡,其中PAIS相关病死率为7.9%(8/101)。MRS评分为1~5分的49例患儿中,89.8%(44/49)为运动障碍,16.3%(8/49)为语言障碍,10.2%(5/49)为癫痫,10.2%(5/49)为智力损害,4.1%(2/49)呈记忆力障碍。4例患儿在随访期内复发。婴儿期发病、心源性卒中、意识障碍、多支血管受累可能为PAIS严重致残、致死的危险因素。结论多数PAIS患儿预后尚可,但仍有一定比例的致死率及致残率。婴儿期发病、合并意识障碍、心源性卒中、多支血管病变为预后不良的危险因素。Objective To investigate the prognosis of pediatric arterial ischemic stroke(PAIS).Methods We retrospectively analyzed the clinical data of patients aging from 1 month to 18 years old who were diagnosed with PAIS at the Emergency Department of Beijing Children′s Hospital from July 2015 to April 2020.We used the modified Rankin scale(MRS)to evaluate patients.We analyzed their recovery of neurological function,mortality rates,and the recurrence of PAIS,while statistically calculating the risk factors leading to disability and death caused by PAIS.Results A total of 101 children with PAIS were involved.During the follow-up period,32.7%(33/101)had no obvious neurological sequelae(MRS 0),and 24.8%(25/101)had mild symptoms that did not affect the patients′daily life(MRS 1).The proportion of mild disability(MRS 2)and moderate to severe disability(MRS 3-5)were 13.9%(14/101)and 9.9%(10/101),respectively.Notably,18.8%(19/101)of the patients died during the follow-up period,and PAIS-related fatality rate was 7.9%.Of the 49 patients with MRS score of 1-5,89.8%(44/49)had dyskinesia,16.3%(8/49)had language disorder,10.2%(5/49)had epilepsy,10.2%(5/49)had intellectual impairment,and 4.1%(2/49)had memory impairment.Four children relapsed during the follow-up period.Infantile onset,cardiogenic stroke,consciousness disorder and multiple angiopathy may be the risk factors of severe disability and death of PAIS.Conclusion PAIS has a certain probability of mortality and disability.Infantile onset,complicated with consciousness disorder,cardiogenic stroke and multiple angiopathy are risk factors for poor prognosis.

关 键 词：动脉缺血性脑卒中 脑梗死 儿童 预后 改良Rankin量表 

分 类 号：R743.3[医药卫生—神经病学与精神病学]