老年重症脑卒中患者发生多器官功能障碍综合征危险因素的分析  

Risk factors for multiple organ dysfunction syndrome in elderly patients with severe stroke

作　　者：孙超文 金聪丽 陈增强 陶华 Sun Chaowen;Jin Congli;Chen Zengqiang;Tao Hua(Department of Neurology,Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000,Guangdong Province,Chin)

机构地区：[1]广东医科大学附属医院神经内科,湛江524000

出　　处：《中华老年心脑血管病杂志》2024年第8期921-925,共5页Chinese Journal of Geriatric Heart,Brain and Vessel Diseases

基　　金：广东省医学科学技术研究基金(A2022203)。

摘　　要：目的探讨老年重症脑卒中患者发生多器官功能障碍综合征(multiple organ dysfunction syndrome,MODS)的危险因素。方法前瞻性选择2020年1月至2022年12月广东医科大学附属医院收治的老年重症脑卒中患者112例。根据入院后14 d内多器官功能评分系统分为MODS组38例,非MODS组74例。根据最终预后又分为生存组33例和死亡组79例。收集患者一般临床资料、急性生理学与慢性健康状况评估Ⅱ(acute physiology and chronic health evaluation,APACHEⅡ)评分、格拉斯哥昏迷评分(Glasgow coma scale,GCS)和头颅影像学参数。采用logistic回归分析MODS发生的危险因素。结果MODS组脑卒中/脑出血、慢性阻塞性肺疾病、冠心病、吸烟、美国国立卫生研究院卒中量表(National Institute of Health Stroke Scale,NIHSS)评分、APACHEⅡ评分、多支血管病变、尿路感染、静脉血栓、出血、癫痫、心肌梗死、急性期机械通气、渗透疗法和住院病死率明显高于非MODS组,GCS明显低于非MODS组,差异有统计学意义(P<0.05,P<0.01)。二元logistic回归分析显示,NIHSS评分、APACHEⅡ评分及多支血管病变是MODS发生的独立危险因素(OR=1.124,95%CI:1.121~1.163,P=0.015;OR=1.265,95%CI:1.296~1.426,P=0.001;OR=2.532,95%CI:1.126~5.013,P=0.026)。死亡组MODS评分、APACHEⅡ评分明显高于生存组,差异有统计学意义(P<0.05)。结论老年重症脑卒中患者急性期易发生MODS。Objective To investigate the risk factors for multiple organ dysfunction syndrome(MODS)in elderly patients with severe stroke.Methods A total of 112 elderly severe stroke patients admitted to our hospital from January 2020 to December 2022 were recruited prospectively,and then according to the results of sequential organ failure assessment(SOFA)within 14 d after admission,they were divided into MODS group(n=38)and non-MODS group(n=74).Based on their clinical outcomes,they were also assigned into survival group(n=33)and death group(n=79).General clinical data,acute physiology,chronic health evaluationⅡ(APACHEⅡ)score,Glasgow coma scale(GCS)score,and head computed tomography parameters were collected.Logistic regression analysis was used to analyze the risk factors of MODS.Results The MODS group had significantly larger proportions of stroke/hemorrhage,chronic obstructive pulmonary disease,coronary heart disease and smoking,higher NIHSS and APACHEⅡscores,elevated ratios of multi-vessel disease,urinary tract infection,venous thrombosis,hemorrhage,epilepsy and myocardial infarction,more patients using acute mechanical ventilation and osmotic therapy,and increased hospital mortality,but lower GCS score when compared with the non-MODS group(P<0.05,P<0.01).Binary logistic regression analysis showed that NIHSS score,APACHEⅡscore,and multivessel disease were independent risk factors for MODS(OR=1.124,95%CI:1.121-1.163,P=0.015;OR=1.265,95%CI:1.296-1.426,P=0.001;OR=2.532,95%CI:1.126-5.013,P=0.026).The MODS score and APACHEⅡscore were significantly higher in the death group than the survival group(P<0.05).Conclusion Elderly severe stroke patients are prone to MODS during the acute period.

关 键 词：卒中 多器官功能衰竭 危险因素 LOGISTIC模型 器官功能障碍评分 

分 类 号：R743.3[医药卫生—神经病学与精神病学]