脑卒中再入院的原因及其危险因素分析

目的探讨脑卒中患者出院后的再入院风险及其危险因素。方法患者样本来源于2009年01月01日至2011年06月30日南京脑科医院，急性脑卒中入院患者。对所有患者，进行入院原因调查与出院后再入院随访。主要再入院原因被分类为：脑卒中再发、神经系统后遗症、心血管事件、感染及其他原因。采用Kaplan—Meier生存分析评估患者再入院的风险，COX比例危险模型评估患者第一次再入院的危险因素。结果总计有效病例为529例，最长随访天数为1282d。随访中再入院患者为210例。通过Kaplan—Meier生存曲线分析表明，再入院风险在30d为6．8％，在90d为12．7％，在180d为18．9％，在360d为27．8％，720d为39．9％。最常见的再入院原因为脑卒中再发，神经系统后遗症，心血管事件等。在COX比例危险模型中，脑卒中病史（P=0．04），急性感染史（P=0．02），血脂异常史（P=0．04）以及低密度脂蛋白胆固醇（LDL—C）（P=0．00），以上因素对患者再入院的影响，具有统计学意义。结论脑卒中患者在出院后再入院的几率非常高，脑卒中复发和各种并发症成为最为重要的原因。容易忽视或不易戒除的因素，如血脂，吸烟等，对患者再入院有一定的提示作用。

The reasons and risk factors of acute stroke rehospitalization

Objective To investgate the risk of rehospitalization and risk factors for stroke patients after leaving hospital. Methods The inpatients of Nanjing Brain Hospital, who subjected to acute stroke from Jan 1, 2009 to Jun 30, 2011, were recruited to the study and followed up from the date of leaving the hospital. The main reasons of rehospitalization were categorized as recurrent stroke, neurologic sequelae of stroke, other cardiovascular event, infection, and others. The Kaplan-Meier method was used to estimate the risk of readmission, while the Cox proportional hazards models were applied to evaluate the risk factors for the first readmission. Results A total of 529 patients were recruited, with the longest follow-up time is 1282 days. The number of rehospitilization patients is 210. Using the Kaplan-Meier method, the risk of readmission at 30 days was 6.8%, at 90 days 12.7%, at 180 days 18.9%, at 360 days 27.8%, and at 720 days 39.9%. The most common reasons for rehospitalization were recurrent stroke, neurologic sequelae of stroke, and cardiovascular events. Using the Cox proportional hazards models, the rehospitalization was associated to the history of stroke, dyslipidemia, acute infection and low density lipoprotein （P〈0.05 or 0.01, the rehospitalization group versus the non-rehospitalization group）. Conclusion Stroke survivors are high risk of readmission, which is mostly due to recurrent stroke and the complications. Some factors including hyperlipemia and smoking, which are easily neglected or diffcult to withdraw, may be important indictators for rehospitilization.