糖化血红蛋白对急性心肌梗死患者预后的影响

目的观察糖化血红蛋白(HbA1c)对急性心肌梗死患者预后的影响。方法选择发病时间12 h、ST段抬高心肌梗死患者541例。根据入院时HbA1c水平分为2组:HbA1 c升高组206例(HbA1c≥6.5%)和对照组335例(HbA1 c6.5%),分析HbA1c水平对患者预后的影响。结果 2组在年龄、吸烟、前壁急性心肌梗死、发病至就诊时间、冠状动脉造影、再灌注成功率、双支血管病变及住院期间药物治疗方面差异无统计学意义(P0.05)。HbA1c升高组患者糖尿病、高血压、血糖水平、3支血管病变、住院期间发生心力衰竭、心源性休克及病死率明显高于对照组;男性比例、LVEF及单支血管病变比例明显低于对照组。多因素分析结果显示,HbA1c升高是影响住院期间发生心力衰竭(OR=1.355,95% CI:0.498～2.788,P=0.039)及病死率(OR=0.872,95% CI:0.421～1.733,P=0.041)的独立危险因素。结论 HbA1c水平升高是住院期间发生心力衰竭及病死率的预测因素,应重视HbA1c对判断急性心肌梗死患者预后的作用,指导患者控制血糖,改善预后。     

血清前白蛋白降低对急性脑梗死患者住院期间死亡的预测

目的观察急性脑梗死患者发病早期血清生化及血常规指标与住院期间死亡的关系。方法回顾性分析发病72 h内就诊的急性脑梗死患者1089例,根据出院时存活状态分为死亡组(36例)和存活组(1053例)。记录患者年龄、性别、首次静脉血清生化指标(白蛋白,前白蛋白,肌酐)和血常规指标(血球压积,血红蛋白)。结果与存活组比较,死亡组患者年龄、肌酐水平明显增高,白蛋白、前白蛋白、血球压积和血红蛋白明显降低,差异有统计学意义(P0.01)。随白蛋白水平降低,患者死亡率明显增加,差异有统计学意义(P0.01)。随前白蛋白水平降低,患者死亡率明显增加,差异有统计学意义(P0.01)。logistic回归分析表明,住院期间死亡与血清前白蛋白(OR=1.276,95%CI:1.196～1.361,P0.01)以及肌酐(OR=0.991,95% CI:0.987～0.995,P0.01)密切相关。结论血清前白蛋白水平下降可以预测急性脑梗死患者住院期间死亡。     

急性脑梗死早期患者血糖水平对预后的影响

目的：观察急性脑梗死早期患者血糖水平对预后的影响。方法104例发病72 h内入院的急性脑梗死患者,入院后立即行血清葡萄糖测试,采用美国国立卫生研究院卒中量表（ NIHSS）进行评分,运用改良Rankin残障量表评分（mRs）评估预后。结果104例急性脑梗死患者中,43例（41．3％）出现高血糖,高血压（OR＝3．655,95％CI：1．218～10．969,P＜0．05）、糖尿病（OR＝17．714,95％CI：3．568～87．939,P＜0．05）、NIHSS评分（OR＝2．731,95％CI：1．637～5．458,P＜0．05）为急性脑梗死后高血糖的独立危险因素。 NIHSS评分（OR＝0．322,95％CI：0．181～0．572,P＜0．05）、高血糖（OR＝6．782,95％CI：1．654～26．373,P＜0．05）为预后不良的独立危险因素。结论部分急性脑梗死患者早期血糖升高,高血糖为急性脑梗死预后不良的独立危险因素。     

炎性标记物对急性脑梗死患者早期预后的影响

目的 探讨炎性标记物对急性脑梗死患者早期预后的影响. 方法 连续收集急性脑梗死患者272例,将脑梗死患者按超敏C反应蛋白(hs-CRP)水平分为低hs-CRP组(hs-CRP≤3 mg/L)及高hs-CRP组(hs-CRP＞3 mg/L),采集研究对象的基本信息和疾病史,同时进行入院后的TOAST卒中分型,美国国立卫生研究院卒中量表(NIHSS)、Barthel指数(BI)和改良的Rankin量表(mRS)评分收集,检测入院后24 h内血白细胞计数、血糖、血同型半胱酸及hs-CRP值.并采用多因素Logistic回归分析进行急性脑梗死早期预后不良的独立危险因素探讨. 结果 高hs-CRP水平组较低hs-CRP水平组的患者心房颤动病史、心源性脑栓塞、血同型半胱氨酸、血糖、白细胞计数,入院后(1d、7d、14 d)NIHSS评分、BI评分和mRS评分差异均有统计学意义(P＜0.05).hs-CRP(OR=0.876,95％CI:0.817～0.917,P＜0.001)、白细胞计数(OR=1.137,95％ CI:1.013～1.275,P=0.029)、脂代谢紊乱(OR=2.863,95％CI:1.561～5.250,P＜0.001)及卒中后第1天BI评分(OR=1.038,95％ CI:1.001～1.077,P=0.047)是急性脑梗死患者早期预后不良的独立危险因素.结论 炎性标记物hs-CRP及白细胞数增高可能是急性脑梗死患者早期预后不良的独立危险因素.     

急性脑梗死合并2型糖尿病患者静脉溶栓的效果分析

目的探讨糖尿病对急性脑梗死静脉溶栓的疗效及安全性分析。方法回顾分析该院神经内科2015年1—12月连续收集的行r-TPA静脉溶栓治疗的急性脑梗死患者90例,其中糖尿病患者36例,非糖尿病患者54例,比较两组间1周时NIHSS评分,3月时m RS评分;及安全性指标(溶栓后出血转化、病死率单因素及多因素回归分析远期预后)。结果糖尿病组与非糖尿病组近期预后间差异无统计学意义(P0.05);糖尿病组远期预后良好率低于非糖尿病组差异有统计学意义(P0.05);二元回归分析发现,糖尿病是影响远期预后的独立危险因子(OR=0.22)。结论糖尿病对急性脑梗死静脉溶栓近期预后无影响,但是影响静脉溶栓远期预后的独立危险因子之一。     

老年冠心病患者介入治疗术后的预后因素分析

目的 探讨影响老年冠心病患者介入治疗后的预后因素. 方法 1981例经皮介入治疗后的冠心病患者被分为老年组(≥65岁)801例和对照组(非老年组,＜65岁)1180例.术后随访12～84个月(平均36个月). 结果 老年组全因死亡率明显高于对照组(5.4％和2.3％,P＜0.01);老年组的主要心血管不良事件(MACE)明显高于对照组(18.9％和3.7％,P＜0.01).影响介入治疗后死亡的因素为年龄65岁(OR=1.05,95％ CI=1.02～1.10,P=0.014),左主干病变(OR=4.78,95％ CI=2.36～17.22,P=0.027),冠状动脉3支病变(OR=5.68,95％ CI=3.17～15.32,P=0.018),合并糖尿病(OR=6.24,95％CI=2.11～16.36,P=0.001);影响介入治疗后主要心血管不良事件的因素为年龄65岁(OR=2.06,95％CI=2.23～4.32,P=0.007),左主干病变(OR=3.64,95％CI=1.86～15.34,P=0.001),冠状动脉3支病变(OR=4.35,95％CI=2.54～13.82,P=0.017),合并糖尿病(OR=5.35,95％ CI=1.77～14.51,P=0.001).性别和高血压不是影响总死亡率和主要心血管不良事件的因素. 结论 年龄、糖尿病、左主干病变、冠状动脉3支病变是影响老年冠心病患者介入治疗预后的主要因素,而性别和高血压对预后影响不明显.     

早期肠内营养对大面积脑梗死患者预后的影响

目的 观察早期肠内营养对大面积脑梗死患者预后的影响.方法 120例大面积脑梗死患者,其中88例入院48 h内接受肠内营养（早期组）,32例入院48 h后接受肠内营养（延迟组）,比较两组院内继发感染发生情况、入住NICU时间、致残率和院内病死率.结果 两组共20例出现院内死亡,早期组院内获得性肺炎发生率、败血症发生率、入住NICU时间、院内病死率明显低于延迟组（P均＜0.01）.早期组入院后第14天血清CRP水平低于延迟组组（P＜0.01）.入院后开始肠内营养的时间与入住NICU时间、CRP水平呈正相关关系（r=0.592、0.380,P均＜0.01）.120例患者中,院内死亡21例,与生存者相比,在梗死灶最大面积、入院时格拉斯哥昏迷评分（GCS）,和医院获得性肺炎发生率方面差异有统计学意义.生存者行早期营养支持所占比例大于院内死亡者（P＜0.01）.早期肠内营养（OR=0.231,95％ CI：0.073 ～0.813）、医院获得性肺炎（OR=5.192,95％ CI：1.823～18.956）和入院时GCS（OR=1.478,95％ CI：1.159 ～1.899）是大面积脑梗死患者院内死亡的独立危险因素.结论 早期肠内营养有助于降低大面积脑梗死患者院内感染率、病死率,改善患者预后.     

进口与国产药物洗脱支架治疗急性ST段抬高心肌梗死的预后分析

目的 进口和国产药物洗脱支架（DES）治疗急性ST段抬高心肌梗死（STEMI）的住院期间与远期预后比较.方法 连续入选2009年1月至2010年8月的197例确诊急性STEMI并行冠状动脉介入治疗的患者,按照支架的类型分为国产DES组和进口DES组,比较两组住院期间和长期心脑血管事件发生率.结果 国产DES组共113例（57.4％）,进口DES组84例（42.6％）,两组住院期间全因死亡率（2.7％比4.8％,P=0.515）、严重心力衰竭发生率（2.7％比0,P=0.053）、恶性心律失常发生率（10.6％比3.6％,P=0.098）差异均无统计学意义;两组患者随访中位数41个月,随访期内两组的无事件生存率分别为91.5％和90.9％ （P=0.885）.多因素分析显示,高龄（HR=1.872,95％ CI：1.008～2.118,P=0.023）、高血压史（HR=6.018,95％ CI：1.307～21.716,P=0.021）、脑血管病史（HR=4.995,95％ CI：1.536～16.242,P=0.008）、心功能Killip分级（HR=3.947,95％ CI：1.809～8.612,P=0.001）、高尿酸血症（HR=1.006,95％ CI：1.003～1.010,P＜0.001）是患者远期发生全因死亡、非致死性心肌梗死、再次血运重建、严重心力衰竭、脑血管病的独立危险因素.结论 急性STEMI患者,应用国产与进口DES住院期间及远期预后差异无统计学意义.     

中年急性脑梗死患者复发的危险因素分析

目的 探讨中年急性脑梗死患者复发的危险因素.方法 收集207例中年急性脑梗死患者,采用前瞻性研究随访2年,记录其复发和死亡事件.根据患者复发情况,分为复发组、未复发组,分析两组的相关危险因素.结果 207例患者中,5例失访,2例死于其他疾病,共入选200例.2年内复发37例(18.5％).单因素分析发现,两组高血压史、冠心病史、高尿酸、空腹高血糖、尿蛋白阳性比较有统计学意义(P均＜0.05)；多因素Logistic回归分析发现,高尿酸血症(OR=2.962,95％ CI为1.281 ～ 6.849,P＜0.05)、空腹高血糖(OR=2.838,95％ CI为1.301～6.192,P＜0.01)、尿蛋白阳性(OR=2.912,95％ CI为1.212 ～6.998,P＜0.05)可以预测脑梗死复发.结论 高尿酸血症、空腹高血糖、尿蛋白阳性为中年急性脑梗死患者复发的重要危险因素.     

急诊PCI治疗急性心肌梗死合并心源性休克效果观察

目的 观察急诊经皮冠状动脉介入术(PCI)治疗急性心肌梗死(AMI)并发心源性休克(CS)患者近期疗效,并分析患者住院病死率与发病至梗死相关动脉(IRA)开通时间的关系.方法 AMI合并CS患93例,按照是否行PCI治疗分为PCI组和对照组,分析患者住院病死率及IRA开通时间.结果 PCI组住院死亡40例(75.0％),对照组为48例(81.0％),两组相比,P＞0.05.PCI组IRA开通时间＜6h患者和≥6 h的患者的病死率分别为54.55％ (6/11)及85.71％(36/42),IRA开通时间＜6h患者的病死率较低(P＜0.01).结论 早期行PCI可缩短AMI合并CS患者发病至IRA开通时间,降低PCI治疗AMI合并CS患者近期住院病死率.     

Arterial carbon dioxide tension on admission as a marker of in-hospital mortality in community-acquired pneumonia

PURPOSE: Respiratory failure is the leading cause of death among patients admitted with community-acquired pneumonia. We sought to determine the association between arterial carbon dioxide tension (P(a)CO(2)) and in-hospital mortality in patients admitted with pneumonia. METHODS: We analyzed data from 2171 patients aged >or=17 years who had been admitted for community-acquired pneumonia to an acute care hospital in Edmonton, Alberta. We compared the risk of all-cause in-hospital mortality using a Cox proportional hazards model across categories of P(a)CO(2). RESULTS: Overall, in-hospital mortality was 10% (n = 218). Compared with patients with normal P(a)CO(2) values (40 to 44 mm Hg), in-hospital mortality was greater (adjusted odds ratio [OR] = 1.8; 95% confidence interval [CI]: 1.0 to 3.2) among patients with hypocapnia (P(a)CO(2) <32 mm Hg). In-hospital mortality was also greater (OR = 2.6; 95% CI: 1.5 to 4.5) in patients with hypercapnia (>or=45 mm Hg). In-hospital mortality was similar in patients with P(a)CO(2) values between 32 and 35 mm Hg (OR = 1.55; 95% CI: 0.89 to 2.79) and those with values between 36 and 39 mm Hg (OR = 1.42; 95% CI: 0.77 to 2.61). CONCLUSION: Among patients admitted with community-acquired pneumonia, in-hospital mortality was greater in those with hypocapnia or hypercapnia. These data suggest that measurement of P(a)CO(2) adds prognostic information to standard prediction rules and should be used for clinical and epidemiologic purposes to risk-stratify in-hospital patients with community-acquired pneumonia.     

影响急性缺血性卒中患者静脉溶栓治疗的院内延误因素分析

目的探讨急性缺血性卒中患者应用阿替普酶静脉溶栓治疗的院内延误影响因素。方法回顾性连续纳入2006年1月至2015年5月华北理工大学附属唐山市工人医院神经内科收治的急性缺血性卒中患者220例,均接受阿替普酶静脉溶栓治疗,入院时美国国立卫生研究院卒中量表评分平均为(16±8)分。根据患者到达医院至静脉溶栓的时间(DNT),分为延误组(DNT60 min,151例)和非延误组(DNT≤60 min,69例)。记录两组基线资料、实验室检查、发病到入院时间、影像学检查、急性卒中Org 10172治疗试验(TOAST)病因分型,对两组进行单因素分析,并进一步行多因素Logistic分析。结果 (1)非延误组既往有短暂性脑缺血发作病史的比例、入院时血糖水平、发病到入院时间均高于延误组,组间差异均有统计学意义[43.5%(30/69)比3.3%(5/151)、(7.9±3.0)mmol/L比(6.9±2.1)mmol/L、(95±53)min比(80±34)min,均P0.05];两组TOAST分型构成比差异有统计学意义(P0.05);其余基线资料及临床特征的组间差异均无统计学意义(均P0.05)。(2)多因素Logistic回归分析显示,患者既往有短暂性脑缺血发作病史(OR=0.330,95%CI:0.109~0.998,P=0.046)、入院时血糖水平升高(OR:0.775,95%CI:0.657~0.914,P=0.005)、发病到入院时间延长(OR=0.648,95%CI:0.504~0.831,P=0.013)、颈内动脉病变(OR=0.192,95%CI:0.038~0.960,P=0.044)发生溶栓治疗院内延误的风险低;入院时收缩压升高(OR=1.275,95%CI:1.091~1.491,P=0.027)、心源性脑栓塞(OR=3.892,95%CI:1.661~9.112,P=0.006)发生溶栓治疗院内延误的风险高。结论患者既往有短暂性脑缺血发作病史、入院时血糖较高、发病到入院时间较长、存在颈内动脉病变,可能引起家属和诊后医师的重视,不易发生溶栓院内延误,而入院时收缩压较高、心源性脑栓塞易发生院内延误。     

Syncope in the German Nationwide inpatient sample – Syncope in atrial fibrillation/flutter is related to pulmonary embolism and is accompanied by higher in-hospital mortality

AimsSyncope is a common phenomenon in the general population. Although most of the causes are of benign origin, some comorbidities are accompanied by high mortality.We aimed to compare the in-hospital mortality of patients with syncope related to different comorbities and investigate the impact of syncope in patients with atrial fibrillation/flutter (AF).MethodsThe nationwide inpatient sample of Germany of the years 2011–2014 was used for this analysis. Patients with syncope (ICD-code R55) were stratified by presence of selected comorbidities. Additionally, AF patients with and without syncope were compared. Incidence of syncope and in-hospital mortality were calculated. Syncope as a predictor of adverse outcome in AF patients was investigated.ResultsIn total, 1,628,859 hospitalizations of patients with syncope were identified; incidence was 504.6/100,000 citizens/year with case-fatality rate of 1.6%. Patients with syncope revealed frequently comorbidities as AF, heart failure and pneumonia. In-hospital mortality was high in syncope patients with pulmonary embolism (PE, 13.0%), pneumonia (12.8%), myocardial infarction (MI, 9.7%) and stroke (8.5%).We analysed 1,106,019 hospitalizations (52.9% females, 54.9% aged > 70 years) of patients with AF (2011–2014). Among these, 23,694 (2.1%) were coded with syncope and 0.7% died. Syncope had no significant impact on in-hospital mortality (OR 1.04, 95%CI 0.92–1.17, P = .503) independently of age, sex and comorbidities, but was associated with PE (OR 1.83, 95%CI 1.42–2.36, P < .001), MI (OR 1.68, 95%CI 1.48–1.90, P < .001), stroke (OR 1.66, 95%CI 1.42–1.94, P < .001) and pneumonia (OR 1.26, 95%CI 1.16–1.37, P < .001).ConclusionsSyncope is a frequent cause for referrals in hospitals. While the overall in-hospital mortality rate is low (<2%), syncope in coprevalence with PE, pneumonia, MI and stroke showed a mortality rate > 8%. Syncope in AF patients had no independent impact on in-hospital mortality.     

他汀类药物对缺血性脑卒中相关性肺炎的预防作用

目的:调查他汀类药物对急性缺血性脑卒中患者并发卒中相关性肺炎(SAP)的预防作用。方法:回顾性分析3492例急性缺血性脑卒中患者的临床资料,并采用logistic回归分析预测发生SAP的危险因素。结果:97例患者死亡,489例患者发生SAP,使用他汀类药物的患者SAP发生率显著低于未使用该药物的患者(12. 0%vs 17. 2%,P 0. 01),多因素分析显示,年龄、改良Rankin量表(mRS)评分、国立卫生研究院卒中量表(NIHSS)评分、吞咽困难、合并心源性栓塞和未采用他汀类药物治疗是SAP发生的危险因素;在调整其他危险因素后,吞咽困难OR值最高(OR=3. 71,95%CI:2. 7～5. 1)。多因素logistic回归分析显示未接受他汀类药物治疗、mRS评分和不明原因的诊断会影响病死率,发生SAP的OR值最高(OR:5. 62,95%CI:3. 40～9. 29)。结论:SAP是患者死亡的主要危险因素,他汀类药物能预防急性缺血性脑卒中患者SAP的发生,并可改善患者的预后。     

Heart rate on admission independently predicts in-hospital mortality in acute ischemic stroke patients

Background

Higher heart rate (HR) is associated with worse outcomes – in particular death – in long term follow-up of patients with vascular diseases. We investigated the association between HR measured on admission and early in-hospital mortality in acute ischemic stroke patients.

Methods

Over a period of 30 months all patients admitted to our hospital with acute ischemic stroke but without atrial fibrillation were prospectively enrolled. Univariate and multiple logistic regression analyses were conducted to estimate the impact of HR on in-hospital mortality. HR was analyzed as continuous and categorical variable (tertiles).

Results

A total of 1335 patients (median age 73 (IQR 65–81), median National Institutes of Health Stroke Scale score 4 (IQR 2–8), median length of stay 5 days (IQR 4–7), female sex 46%) were studied. In-hospital mortality was 2.6%. When analyzed as categorical variable, HR ≥ 83 bpm was independently associated with in-hospital mortality after adjustment for predictors of poor outcome compared to the reference tertile (HR ≤ 69 bpm) (adjusted odds ratio 4.42, 95% CI 1.36–14.42, p = 0.01). When HR was modeled as continuous variable, relative risk for in-hospital death was elevated by 40% for every additional 10-bpm (p = 0.003). These results were not changed by including beta-blockers as covariate into the multiple regression model.

Conclusions

HR on admission is independently associated with in-hospital mortality in acute ischemic stroke patients suggesting early negative effects of autonomic imbalance. HR may represent a therapeutic target to improve outcome after ischemic stroke.     

Heart failure on admission and the risk of stroke following acute myocardial infarction: the VALIANT registry.

AIMS: We sought to assess the relative contribution of heart failure (HF) on admission for an acute myocardial infarction (MI) to the subsequent in-hospital stroke risk. METHODS AND RESULTS: The VALsartan In Acute myocardial iNfarcTion (VALIANT) registry enrolled 5573 consecutive MI patients at 84 international sites from 1999 to 2001. We calculated odds ratios (ORs) for stroke and adjusted for baseline characteristics, Killip Class, and risk factors for stroke, such as diabetes and prior HF. In-hospital stroke occurred in 81 (1.5%) patients. HF was present on admission in 38% of patients who developed a stroke and in 24% who did not (P=0.001). Older age (OR 1.03 increase/year, 95% confidence interval (CI) 1.01-1.04), Killip Class III (OR 1.66, CI 0.86-3.19) or IV (OR 4.85, CI 1.69-13.93), history of hypertension (OR 1.73, CI 1.06-2.82), and history of stroke (OR 1.89, CI 1.06-3.37) were more common in patients who had in-hospital stroke. In-hospital mortality in patients with and without stroke was 27.2 and 6.5%, respectively (P<0.001). CONCLUSION: Patients with stroke after MI have a dismal prognosis. The presence of HF on admission for an acute MI increases in-hospital stroke risk. HF treatments may modify the risk of stroke.     

Hyperfibrinogenemia predicts long-term risk of death after ischemic stroke

In stroke patients higher levels of plasma fibrinogen are associated with increased risk of unfavourable functional outcome and short-term mortality. The aim of our study was to determine the relationship between plasma fibrinogen level and long-term risk of death in ischemic stroke patients. Seven hundred thirty six patients (median age 71; 47.1 % men) admitted to the stroke unit within 24 h after stroke were included. Plasma fibrinogen level was measured on day 1 of hospitalisation. Hyperfibrinogenemia was defined as plasma fibrinogen concentration >3.5 g/L. The maximal follow-up period was 84 months. Hyperfibrinogenemia was found in 25.0 % of patients. On multivariate logistic regression analysis, after adjustment for age, stroke severity, atrial fibrillation, smoking, white blood cell count, fever, in-hospital pneumonia and hyperglycemia, hyperfibrinogenemia was associated with increased case fatality (HR 1.71, 95 % CI 1.29–2.26, P < 0.01). Hyperfibrinogenemia predicts the long-term risk of death in ischemic stroke patients.     

缺血性小卒中转归不良的相关因素

目的：探讨缺血性小卒中患者转归不良的危险因素。方法前瞻性纳入缺血性小卒中患者,在发病后90 d时应用改良Rankin量表评估临床转归,0~2分定义为转归良好。对转归良好组与转归不良组人口统计学资料、血管危险因素、临床资料、影像学资料、卒中病因学分型、实验室化验结果、治疗方法等进行比较,采用多变量logistic回归分析确定缺血性小卒中患者早期转归不良的独立危险因素。结果共纳入516例缺血性小卒中患者。发病后90 d时90例（17.44％）转归不良,426例（82.56％）转归良好。多变量logistic回归分析显示,年龄[优势比（odds ratio, OR）1.045,95％可信区间（confidence interval, CI）1.017~1.074;P=0.002]、心脏病（OR 2.021,95％CI 1.063~3.841;P=0.032）、基线美国国立卫生研究院卒中量表（ National Institutes of Health Stroke Scale, NIHSS）评分（OR 1.662,95％CI 1.177~2.347;P=0.004）、肢体运动障碍（OR 2.430,95％CI 1.010~5.850;P=0.048）、共济运动障碍（ OR 2.929,95％CI 1.188~7.221;P=0.020）、早期神经功能恶化（OR 50.994,95％CI 17.659~147.258;P<0.001）、梗死灶直径（OR 1.279,95％CI 1.075~1.521;P=0.005）、非责任血管狭窄（ OR 2.518,95％CI 1.145~5.536;P=0.022）、大动脉粥样硬化性卒中（ OR 2.010,95％CI 1.009~4.003;P=0.047）是缺血性小卒中转归不良的独立危险因素。结论缺血性小卒中早期转归不良与年龄、心脏病史、基线NIHSS评分、肢体运动障碍、共济运动障碍、早期神经功能恶化、梗死灶直径、非责任血管狭窄、大动脉粥样硬化性卒中密切相关,需早期完善相关检查,明确病因分型,指导临床进行正确治疗。     

A型主动脉夹层术后严重高胆红素血症并发急性肾损伤患者的预后及危险因素

目的 探讨A型主动脉夹层术后严重高胆红素血症并发急性肾损伤（AKI）患者的预后及危险因素。 方法 回顾性筛选西京医院2015年1月~2018年12月行A型主动脉夹层手术治疗的患者,术后同时发生严重高胆红素血症和AKI的患者被纳入研究。研究终点包括住院死亡和长期死亡。采用单因素和多因素分析住院死亡相关的危险因素,使用Kaplan-Meier生存曲线来评估患者的长期生存率以及AKI的不同分期对长期生存的影响。 结果 221例患者被纳入研究,50例患者接受持续性肾脏替代治疗（CRRT）,82例患者住院死亡。1年、2年和3年累积病死率分别是39.0%、40.2%和41.1%。多因素Logistic 回归分析显示,A型主动脉夹层术后严重高胆红素血症并发AKI患者死亡的独立危险因素为:术后第1天平均动脉压（OR0.967,95%CI 0.935-1.000;P<0.01）、术后机械通气时长（OR 1.189,95%CI 1.003-1.410;P<0.05）、术后总输血量（OR 1.019,95%CI 1.003-1.036;P<0.05）以及AKI 3期（OR 12.639,95%CI5.409-34.388;P<0.01）。 结论 A型主动脉夹层术后严重高胆红素血症并发AKI患者的住院病死率以及长期病死率较高。AKI 3期,术后较低的平均动脉压,延长的术后机械通气以及增加的术后输血量是患者住院死亡的危险因素。因此,临床医生应该更密切地监测具有这些高风险的患者。     

Prior heart failure among patients with acute coronary syndromes is associated with a higher incidence of in-hospital heart failure

BACKGROUND: There are few data regarding the impact of prior heart failure (P-HF) on the presentation, course and outcomes of acute coronary syndromes (ACS). METHODS AND RESULTS: We prospectively analyzed all ACS patients admitted in all cardiology wards in Israel during February and March, 2004. Of the 2098 patients, 156(7.4%) had P-HF. These patients were older (75 [66.5-81] versus 63 [53-74] years, (P<0.001)) and more often female (38.5% versus 25.0%, P<0.001)), with a higher prevalence of coronary artery disease risk factors, prior cardiac disease and procedures, and other co-morbidities. They more often presented with atypical angina and heart failure and less with ST-elevation (18.6% versus 51.3%, p<0.0001). In-hospital heart failure developed more frequently (15.4% versus 6.1%, p = 0.00001), including cardiogenic shock (7.1% versus 2.9%, p = 0.005), as did persistent atrial fibrillation (6.4% versus 0.7%, p<0.001), but not ischemic complications. After adjustment for differences, P-HF was not independently associated with 30 day or six-month mortality, but at one-year follow-up, it was (OR 1.16, 95% CI 1.0-2.5). P-HF was also independently associated with increased incidence of heart failure upon admission or thereafter in-hospital (OR = 4.3, 95% CI 2.8-6.6). CONCLUSIONS: P-HF ACS patients had high-risk features, lower incidence of ST-elevation, and higher one-year adjusted mortality. P-HF was also independently associated with in-hospital heart failure, suggesting they should be monitored vigilantly.