脑梗死患者住院期间发生消化道出血的危险因素分析  

Analysis of risk factors for gastrointestinal bleeding in patients with cerebral infarction during hospitalization

作　　者：马玲丽 Ma Lingli(Department of Neurology,West Coast New District People′s Hospital of Qingdao,Qingdao,Shandong 266400,China)

机构地区：[1]青岛西海岸新区人民医院神经内科,266400

出　　处：《中国脑血管病杂志》2025年第3期178-187,共10页Chinese Journal of Cerebrovascular Diseases

摘　　要：目的分析脑梗死患者住院期间发生消化道出血的危险因素。方法回顾性连续纳入青岛西海岸新区人民医院神经内科2022年1月至2024年12月因脑梗死入院的患者。收集所有患者的基线资料及治疗情况,基线资料包括年龄、性别、入院时收缩压、入院时舒张压、入院时美国国立卫生研究院卒中量表(NIHSS)评分、既往史[高血压病、糖尿病、冠心病、心房颤动、脑梗死病史、血脂异常、消化道疾病(胃炎、胃溃疡)]、脑梗死部位(前循环、后循环、多发性)、急性卒中Org 10172治疗试验(TOAST)分型、入院时实验室检查指标(血红蛋白、血小板计数、凝血酶原时间、活化部分凝血活酶时间),治疗情况包括抗血小板聚集治疗、抗凝治疗、静脉溶栓治疗、降脂治疗、预防性质子泵抑制剂使用。根据住院期间是否发生消化道出血,将患者分为出血组和非出血组,消化道出血的诊断依据《急性上消化道出血急诊诊治流程专家共识(2020版)》中的诊断标准。比较两组患者的住院时间及住院期间全因死亡患者比例。将单因素分析中差异有统计学意义的变量纳入多因素Logistic回归分析,评估脑梗死患者住院期间发生消化道出血的影响因素。结果共纳入344例脑梗死患者,男201例,女143例,年龄32~91岁,平均(68±12)岁,其中22例(6.4%)发生消化道出血,322例(93.6%)未发生消化道出血。(1)出血组患者年龄[(74±12)岁比(67±12)岁]、入院时NIHSS评分[8(4,20)分比2(2,4)分]、入院时凝血酶原时间[(13.1±1.5)s比(12.4±1.1)s]及冠心病[50.0%(11/22)比20.8%(67/322)]、心房颤动[50.0%(11/22)比15.5%(50/322)]、消化道疾病[27.3%(6/22)比14.3%(46/322)]、静脉溶栓治疗[22.7%(5/22)比2.2%(7/322)]患者比例均高于非出血组,入院时血红蛋白水平[(118±21)g/L比(135±16)g/L]、抗血小板聚集治疗患者比例[59.1%(13/22)比79.5%(256/322)]均低于非出血组,住院期间全因死亡患者�Objective To analyze the risk factors for gastrointestinal bleeding in patients with cerebral infarction during hospitalization.Methods This retrospective study included patients with cerebral infarction admitted to the Department of Neurology at West Coast New District People′s Hospital of Qingdao from January 2022 to December 2024.Baseline characteristics,including age,gender,admission systolic and diastolic blood pressure,and National Institutes of Health stroke scale(NIHSS)score at admission,medical history(hypertension,diabetes mellitus,coronary artery disease,atrial fibrillation,history of cerebral infarction,dyslipidemia,and gastrointestinal disease[gastritis or gastric ulcer]),infarction location(anterior circulation,posterior circulation,or multiple infarcts),trial of Org 10172 in acute stroke treatment(TOAST)classification,laboratory parameters at admission(hemoglobin,platelet count,prothrombin time[PT],and activated partial thromboplastin time)and the treatment status(antiplatelet therapy,anticoagulation,intravenous thrombolysis,lipid-lowering therapy,and prophylactic proton pump inhibitor use)were collected for all patients.Patients were divided into bleeding group and non-bleeding group based on the occurrence of gastrointestinal bleeding during hospitalization as diagnosed according to the Expert Consensus on Emergency Diagnosis and Treatment Procedures for Acute Upper Gastrointestinal Bleeding(2020 Edition).The length of hospital stay and in-hospital all-cause mortality were compared between the two groups.Variables with statistically significant differences in univariate analysis were further examined using multivariate Logistic regression to evaluate the risk factors for gastrointestinal bleeding in patients with cerebral infarction.Results A total of 344 patients with cerebral infarction were enrolled in this study,including 201 males and 143 females,aged 32-91 years,with an average age of(68±12)years.Among them,22 cases(6.4%)were experienced gastrointestinal bleeding,while 322 cases(93.6%)di

关 键 词：脑梗死 消化道出血 危险因素 

分 类 号：R743.33[医药卫生—神经病学与精神病学]