觉醒型脑卒中的临床研究

目的 探讨觉醒型脑卒中患者的临床特点、OCSP分型、危险因素及溶栓治疗等。方法 连续回顾性收集本院神经内科2016年11月-2017年11月住院的新发脑梗死患者作为研究对象,分析觉醒型脑卒中与非觉醒型脑卒中患者的年龄、性别、高血压病、糖尿病、冠心病、心脏瓣膜病及其他原因心脏病、既往脑梗死病史或TIA发作史、抽烟、过量饮酒、高胆固醇血症、高甘油三脂血症、混合型高脂血症、高尿酸、高同型半胱氨酸、H型高血压病、糖尿病合并高血压病、三高症(高血压病、高脂血症、糖尿病)等以及各危险因素与临床OCSP分型的关系。结果 觉醒型脑卒中患者24.05%(70/221),男性68.57%(48/70),平均年龄(66.29±15.20)岁,觉醒型脑卒中组与非觉醒型脑卒中组年龄、性别等临床基线特征没有统计学差异(P>0.05)。房颤在觉醒型脑卒中与非觉醒型脑卒中组比较OR(95% CI)是2.74(1.28～5.86); H型高血压病OR(95% CI)是1.81(1.04～3.15)。2组牛津郡社区脑卒中临床分型占比比较具有统计学差异(P<0.05)。2组在临床分型的危险因素中在觉醒型脑卒中组完全前循环供血区梗死的高尿酸血症存在明显差异(P<0.05)。房颤、高尿酸血症在觉醒型脑卒中OCSP分型中有统计学差异(P<0.05),均在完全前循环供血区的梗死比例较高。在溶栓治疗上觉醒型脑卒中患者溶栓比例为2.86%。结论(1)房颤、H型高血压病可能与觉醒型脑卒中的发生密切相关;(2)觉醒型脑卒中与非觉醒型脑卒中OCSP分型发生率不同;(3)房颤、高尿酸血症可能会加重觉醒型脑卒中患者的神经系统症状,且发生在完全前循环供血区梗死;(4)觉醒型脑卒中溶栓治疗率较低。

The clinical study of wake-up stroke

ObjectiveTo study the clinical data, classification of community stroke project in Oxfordshire, risk factors and thrombolytic therapy of wake-up stroke.Methods Consecutive case series of the new onset cerebral infarction patients in the Department of Neurology of our hospital from November 2016 to November 2017 were collected. The age, gender, hypertension, diabetes, coronary heart disease, valvular heart disease and other causes of heart disease, the history of cerebral infarction or TIA attacks, smoking, excessive drinking, diabetes, high cholesterol, high glycerin three greases, mixed hyperlipidemia, high uric acid, homocysteine, H-type hypertension, diabetic hypertension, three high symptoms(high blood pressure, high blood lipids, high blood sugar)of wake-up stroke and non wake-up stroke patients were analyzed and the relationship was analyzed between the risk factors and clinical classification of OCSP.Results 24.05%(70/221)were wake-up stroke patients, of which 68.57%(48/70)were males, and the mean age was(66.29±15.20)years. There were no significant difference in clinical baseline characteristics(age, gender,et al)between wake-up stroke and non-wake up stroke patients(P>0.05). OR(95% CI)for wake-up compared to non-wake-up were 2.74(1.28～5.86)for atrial fibrillation, 1.81(1.04～3.15)for H-hypertension. There were statistically significant differences in the proportion of clinical classification of community stroke project in Oxfordshire(P<0.05). Among the risk factors of clinical typing, there were significant differences in hyperuricemia(P<0.05)in the complete pre cycle of wake-up stroke. Atrial fibrillation and hyperuricemia were statistically different in the classification of OCSP in wake-up stroke(P<0.05), and all were higher in the total anterior circulation infarction. In thrombolytic therapy, the proportion of thrombolytic therapy in patients with wake-up stroke was 2.86%.Conclusion Atrial fibrillation and H-type hypertension might be closely related to the occurrence of wake-up stroke. There were differents in the incidence of classification of OCSP between wake-up stroke and non-wake up stroke patients. Atrial fibrillation and high uric acid might aggravate the symptoms of the nervous system in wake-up stroke, and had a total anterior circulation infarction. The proportion of thrombolytic therapy in wake-up strokes was low.