中国脑卒中的发病与趋势——三大城市的研究结果

分析1991～2000年北京、上海、长沙3城市社区年登记的卒中病例,了解3大城市90年代脑卒中及其亚型的发病率和变化趋势。经年龄标化后北京初发脑卒中的发病率为135．0/10万人年、上海为76．1/10万人年、长沙为150．0/10万人年,其中北京缺血性卒中的发病率最高,其次为上海和长沙;而长沙颅内出血的发生率最高,其次是北京和上海;蛛网膜下腔出血的顺序同脑出血。社区≥50岁的人群总卒中和颅内出血年龄标化后的发病率普遍高于西方国家。从10年变化趋势来看,北京、上海、长沙3大城市颅内出血的年下降率分别为12．0%、4．4%和7．7%,而脑缺血的年增长率除长沙外北京和上海分别为5．0%和7．7%。这种颅内出血减少和缺血性卒中增加的现象反映出中国人群脑卒中危险因素的变化情况。     

长沙市居民脑血管病十年综合防治的效果评价

目的 :探讨社区居民脑血管病综合性防治的效果。方法 :1991～ 2 0 0 0年在长沙市开福区 10万自然人群中 ,按整群抽样分为干预区和对照区 ,分别在 35～ 74岁的 812例和 831人亚组人群中调查收缩压、舒张压、体重指数和血脂等变量 ,作为评价干预效果指标 ,10年后抽取与干预前相同条件下的对象 80 4和 82 6人进行复查 ;同时在干预区进行脑血管病的综合防治。结果 :干预后甘油三酯显著下降 (P<0 .0 1) ,平均舒张压、胆固醇、血糖均得到了有效控制 ;2 0 0 0年干预区脑卒中的年发病率 (粗率和标化率 )及年死亡率 (粗率 )显著低于对照区 (P<0 .0 5～ 0 .0 1)。结论 :社区综合性脑卒中防治是降低脑血管病发病和死亡的有效途径     

上海市社区人群干预前后脑卒中发病率的变化

目的：探索在社区人群中降低脑卒中发病率的有效措施。方法：在“八五”“九五”期间，在上海市静安区的两个街道约9万人群中开展社区脑血管病综合性防治研究。结果：经过9年干预，干预社区脑卒中总发病率呈波动性下降，2000年干预社区脑卒中发病率为130．2／10万，与1991年相比下降了25．8％，而监测社区脑卒中总发病率呈波动性上升，2000年监测社区脑卒中发病率为187．4％／10万，与1991年同组相比上升了13．2％，1996－2000年脑卒中平均发病率与同组的1991－1995年相比，干预社区下降了13．0％，而监测社区上升了11．0％，干预社区不同年龄性别人群的发病率变化趋势与程度不一致，其中以75－84岁人群下降最为明显，结论：以开展健康教育和积极控制高血压，糖尿病为主的综合干预措施对降低脑座中的发病率效果明显。     

北京社区人群卒中早期预警研究

目的 观察评价脑血管血流动力学指标（cerebral vascular hemodynamic indexes,CVHI）检测技术在社区人群中早期预警卒中的可行性。方法 采用前瞻性队列研究方法,选择北京两个社区,以整群抽样的方式抽取40岁以上有当地户籍且无卒中病史的常住居民作为队列人群,进行基线问卷调查、CVHI检测确定CVHI积分以及2.5年卒中发病随访。观察卒中的发病情况,并结合基线时的CVHI积分值进行分析。结果 （1）基线调查2910人,随访2.5年,新发卒中病例40人。其中1590人CVHI积分值＜75分,占检测队列人群的54.64%。（2）40例新发卒中中36例为缺血性卒中（90%）,4例为出血性卒中（10%）,其中75%的患者CVHI积分值＜75分。（3）70岁以上患者占新发卒中的50%,其中90%CVHI积分值＜75分。结论 随着年龄的增长,CVHI积分值降低,卒中发病率上升。CVHI检测技术可以作为一种早期预警卒中的筛查工具在社区人群中应用。     

长沙社区50岁以上人群卒中危险因素和脑血管血流动力学积分的关系

目的 研究长沙市社区50岁以上城市居民卒中危险因素和脑血管血流动力学积分的关系。方法 2008年在长沙市进行50岁以上社区居民的随机抽样,进行卒中常见危险因素（包括高血压、糖尿病、心脏病、高血脂、吸烟、饮酒）的基线调查,同时进行脑血管血流动力学指标（cerebralvascular hemodynamics index,CVHI）检测,并对检测结果进行综合积分。根据有无卒中危险因素将队列人群分为对照组、单一危险因素和多个危险因素组。研究卒中危险因素与CVHI积分的关系。结果 （1）与对照组比较,高血压组和多个危险因素组的CVHI积分明显下降,差异具有统计学意义（P均<0.01）;高血压组和多个危险因素组中高危人群（CVHI积分50～75分）和极高危人群（CVHI积分≤50分）所占比例高于对照组,差异有统计学意义（P均<0.01）。（2）随着危险因素暴露的增加,CVHI积分呈下降趋势,高危人群和极高危人群所占比例呈增高趋势,差异有统计学意义（P <0.01）。结论 高血压病史和多个危险因素的聚集会明显降低脑血管血流动力学积分。     

门诊宣教在脑卒中高危人群一级预防中的应用

我院自2005年成立神经内科门诊宣教室以来,利用病人候诊时间,在卒中高危人群中开展一级预防的护理干预,取得满意的效果,现将干预措施报告如下. 1 脑卒中的高危人群 1.1 高血压 高血压是脑卒中发病最重要的危险因素.77%的初发脑卒中患者都与高血压有关[1],每减少5 mmHg(1 mmHg=0.133 kPa)的舒张压和每减少10 mmHg的收缩压,脑卒中的风险都会降低30%～40%[2].因此,积极治疗和控制高血压是降低脑卒中的有效措施之一.     

北京城区中老年人群吸烟与卒中发病关系的两次横断面调查

目的 探讨北京城区中老年人群吸烟与卒中发病率及卒中类型的关系,以及吸烟对于群体生存时间的影响。方法 选择北京城区2万自然社区人群,随机整群抽样调查5441例（年龄≥35岁）,限于人群随访困难,仅进行间隔10年的两次横断面调查。应用COX比例风险模型分析吸烟与卒中的发病及生存预后的相关性。结果 随访人群卒中发病率高达668.15/10万人年。总卒中发病率排序为：吸烟组（798.56/10万人年）＞戒烟组（754.71/10万人年）＞非吸烟组（591.38/10万人年）,组间差异有统计学意义。吸烟与缺血性卒中和总卒中发生的相关性具有统计学意义。吸烟组生存时间明显降低。结论 吸烟已构成卒中独立的危险因素,吸烟人群卒中的发病率高于非吸烟人群,群体生存曲线降低,影响到群体的生存寿命;此外,中老年人群既是卒中的高危人群,也可能是戒烟的最大受益群体。     

缺血性脑卒中的流行病学研究

据国外研究报道,正常情况下成年女性缺血性脑卒中(ischemic stroke,IS)年发病率为170/10万,男性为212/10万,年平均发病率为0.58%~0.61%;复发率为21.8%~12.9%,其中,伴有房颤的1年脑卒中复发率为10%~20%,发病前和发病后接受过抗血小板治疗的分别为9.0%和6.2%~14.0%。据国内文献统计:缺血性脑卒中发病率为91.3~263.1/10万,年平均发病率为145.5/10万;复发率为8.47%。     

脑卒中3年生存和复发的社区干预效果

目的近20年来,脑卒中是中国人群的主要死亡原因,其发病率随着脑卒中危险因素的增加呈上升趋势。本研究旨在评价初发脑卒中患者3年生存和复发的社区干预效果。方法1991～2000年选择北京2个人口约50 000人的社区分别作为干预和对照社区。采取的综合干预措施包括高危人群管理和社区人群健康教育。对初发脑卒中3年生存和复发的社区干预效果进行评价。结果3年内干预社区736例患者中有41．85%的死亡,而对照社区818例患者中有40．34%的死亡;干预社区223例患者中有26人(11．66%)复发〔RR=0．74,95% CI为(0．61,0．89),P= 0．002〕,对照社区250例患者中有52人(20．80%)复发〔RR=0．61,95% CI为(0．46,0．81),P=0．001〕,2个社区的复发率间差别有显著性意义。对照社区比干预社区脑卒中死亡率下降了26%,尤其是出血性脑卒中下降了39%,同时复发率下降了42%。结论社区干预对预防脑卒中,尤其是出血性脑卒中的复发,改善脑卒中生存是有效的。     

综合性干预对社区高血压患者血压和人群脑卒中发病、死亡的影响

目的研究综合性干预对社区高血压患者血压和人群脑卒中发病、死亡的影响.方法1997～2000年对长沙市35岁以上社区人群中的部分高血压患者进行综合性防治,并监测1996～2000年干预和对照社区人群脑卒中发病和死亡情况.结果干预社区高血压患者收缩压人均下降了4.25mmHg、舒张压人均下降了1.16mmHg(P＜0.01),且不论男女,人均血压均有不同程度的下降;综合干预使干预社区脑卒中发病率下降约50%.结论综合性干预能降低社区高血压患者血压水平,为脑卒中社区防治的有效手段.     

Incidence of venous thromboembolism: a community-based study in Western France. EPI-GETBP Study Group. Groupe d'Etude de la Thrombose de Bretagne Occidentale

The incidence of venous thromboembolism has been studied during one year in a defined population of 342,000 inhabitants. The overall incidence (95% confidence interval) of venous thromboembolism was found to be 1.83 per thousand per year (1.69 to 1.98). The incidences of deep venous thrombosis and pulmonary embolism were 1.24 per thousand per year (1.12 to 1.36) and 0.60 per thousand per year (0.52 to 0.69), respectively. The incidence of venous thromboembolism rose markedly with increasing age for both sexes; over the age of 75, the annual incidence reached 1 per 100. Sixty three percent of the patients were at home when venous thromboembolism occurred. Of these, sixteen percent had been previously hospitalised within three months. These results raise concerns on identification of medical patients at high risk and effective prophylaxis.     

The relationship of restrictions on state hospitalization and suicides among emergency psychiatric patients

OBJECTIVE: This study explored the relationship between mandated decreases in transfers to a state hospital from a large urban psychiatric emergency facility and the occurrence of suicide in the catchment area served. METHODS: During 1996, new admission criteria that emphasized psychiatric diagnosis and potential benefit from hospitalization and that restricted the admission of recidivistic patients and of those with a primary diagnosis of a substance use disorder were phased in. Data on the number of patients seen in a psychiatric emergency service and the number transferred to the state hospital were obtained for the period 1994-1998. Data on all completed suicides in the county served by the hospital were also obtained. RESULTS: During 1994 and 1995, a total of 9,308 patients were transferred to the state hospital. In 1997 and 1998, a total of 4,072 patients were transferred. The number of patients seen in the emergency service remained constant throughout the study period. No change was noted in the absolute number or the rate of suicide in the county after the new admission criteria were implemented. A total of 164 suicides were recorded in 1994-1995 (12 per 100,000 population per year), compared with 152 in 1997-1998 (ten per 100,000 population per year). CONCLUSIONS: Transfers to the state hospital were reduced by 56 percent, with no change in the suicide rate. This finding suggests that the availability of inpatient psychiatric hospitalization may not have a direct effect on the suicide rate.     

Epidemiology of cerebrovascular disease in Tartu, Estonia, USSR, 1970 through 1973.

This study was undertaken to establish the incidence and mortality for various types of cerebrovascular disease in the population of Tartu. All medical records for this population were reviewed for the period 1970 through 1973, and those with a diagnosis of brain infarction, transient ischemic attacks, cerebral hemorrhage or subarachnoid hemorrhage were identified. Only the first stroke was considered when determining incidence. A total of 786 cases were included in the study. Without cases of transient ischemic attacks, the number was 667 (e.g., cases of stroke). Cerebral infarction accounted for 80% of all strokes, cerebral hemorrhage for 13.5% and subarachnoid hemorrhage for 6.5%. The incidence rate for stroke was higher for men than for women and significantly increased in each older age group. The rate for all persons was 184 per 100,000 population per year. The incidence of transient ischemic attacks was 33 per 100,000 population per year. The mortality rate for stroke for this population was 98/100,000 per year. The data on incidence of stroke and its type, its dependence on age and sex, and mortality rate are close to the corresponding data reported from other countries.     

Incidence of stroke in a Finnish prospective population study

The incidence of stroke was investigated in a large Finnish prospective population study. The study population consisted of 11,984 men and 11,682 women aged 15 years and over drawn from four geographical regions of the country. In a mean follow-up time of six years, 174 men and 169 women suffered a fatal or non-fatal stroke. The age-adjusted mean annual incidence of stroke in men, 4.0/1000, was statistically significantly higher than the annual incidence in women, 3.3/1000. In twelve percent of the cases stroke was caused by subarachnoid hemorrhage and in ten percent by cerebral hemorrhage. In 30 percent of the cases, cerebral infarction was ascertained as the cause of the stroke; while in 49 percent of the cases, the type of stroke could not be specified with certainty. The incidence of stroke was significantly higher in non-attendants than in attendants at the initial survey. The incidence of cerebral infarction appeared to be higher in men from eastern Finland than in men from southwestern Finland.     

First-year results of a community-based study of stroke incidence in Umbria, Italy

The SEPIVAC study (Italian initials for "epidemiologic study of incidence of acute cerebrovascular disease") is a community-based epidemiologic survey of incidence and outcome of cerebrovascular disease in the territory of the 6th Local Health Unit, Umbria, Italy, where 49,101 people live. All cases were registered with the study either by notification from general practitioners or by check of hospital admission within the study area and in the two hospitals of Perugia. Death certificates were looked at as well. Patients were registered with the study when the clinical picture fulfilled the definition of stroke and transient ischemic attack (TIA) adopted for this study. Patients were followed up at approximately 30 days and 6 months. During the first year of the study (September 1, 1986 to August 31, 1987), 189 cases were registered: 108 suffered a "first ever in a lifetime" stroke, 30 a recurrent stroke, and 51 a "first ever in a lifetime" transient ischemic attack. Sixty-one percent of patients (71% of first strokes) had a computed tomography scan. For our study, the crude annual incidence rate of first stroke was 2.2 per 1,000 (confidence intervals 1.81-2.66); the standardized rate to the European population was 1.36 (confidence intervals 1.06-1.74). At least 83% of first strokes were due to cerebral ischemia; in 26 cases a clinical diagnosis of lacunar ischemia was made. The 30-day case fatality rate was 21%; 25% of our patients had recovered completely or almost completely after 1 month.