住院天数与急性缺血性脑卒中出院不良结局的关系

目的探索急性缺血性脑卒中病人住院天数与出院不良结局的关系。方法从承德医学院附属医院病案室抽取神经内科2009年5月31日至2013年5月31日所有符合纳入标准的3334病例,对病例资料采用回顾性队列研究的方法,分析急性缺血性脑卒中病患者结局良好组和结局不良组(MRs)脑卒中量表对所有研究对象进行评分,0分≤MRs≤2分为结局良好组,3分≤MRs≤6分为结局不良组的入院时基线,并分析住院天数对急性缺血性脑卒中出院不良结局的差异。结果出院不良结局与结局良好的两组患者间入院基线在年龄、性别、住院天数、是否存在心房颤动及血糖水平等方面差异有统计学意义(p<0.05);对住院天数与发生不良结局进行单因素非条件Logistic回归分析,住院时间为7~14d和14~21d的患者不良结局的出现与住院天数小于7d的患者比较,OR值分别为0.306和0.561,95%CI分别为0.239/0.391和0.434/0.726,两组P值<0.00。多因素非条件Logistic回归分析提示,住院天数为7~14d的不良结局患者与住院时间小于7d的出院不良结局患者差异有统计学意义。结论急性缺血性脑卒中患者结局良好与结局不良组入院基线有差别,住院时间在7~14d为出院不良结局的保护性因素,合理控制住院时间,有助于患者康复治疗,减轻经济负担。     

颈内动脉闭塞患者危险因素的Logistic回归分析

目的探讨颈内动脉闭塞的相关危险因素。方法回顾性分析2003年1月～2008年3月北京友谊医院收治的94例颈内动脉闭塞患者的危险因素,并与2007年1月～2007年6月收治的105例（无颈内动脉闭塞）缺血性脑血管病患者（对照组）的危险因素进行比较,并进行多因素Logistic回归分析。结果2组间缺血性脑血管病常见的危险因素如高血压病、高脂血症、糖尿病、高龄和饮酒史,无统计学差异（P〉0．05）,而性别、脑卒中病史及吸烟史3个因素在2组间具有统计学意义（P〈0．05）。将男性、脑卒中病史及吸烟史3个变量代入Logistic回归方程行多因素分析显示,3种相关危险因素中性别与颈内动脉闭塞相关性最高（P=0．041）,吸烟史和脑卒中病史为仅次于性别的危险因素。结论性别、脑卒中病史及吸烟史是颈内动脉闭塞的重要相关危险因素,临床应加强脑卒中的二级预防,并加强戒烟宣传等工作。     

伴智能障碍的脑白质疏松症患者相关危险因素分析

目的分析伴智能障碍的脑白质疏松症(LA)患者的相关危险因素。方法 207例LA患者分为伴有智能障碍组和无智能障碍组,对患者的性别、年龄、高血压病史、糖尿病史、冠心病史及既往脑梗死病史等进行相关因素分析和Logistic回归分析。结果两组年龄、高血压病史、糖尿病史、既往脑梗死病史和LA的严重程度均有显著差异。多因素回归分析最终入选模型的变量是年龄、高血压病史、既往脑梗死病史和重度LA。结论高龄、高血压病史、既往脑梗死病史和重度LA,对LA是否伴智能障碍有独立的提示作用。     

复发性脑梗死的危险因素分析

目的探讨复发性脑梗死的危险因素。方法对50例复发性脑梗死患者及51例初发性脑梗死患者的危险因素中12个因素进行对比分析,并用多元Logistic回归分析各因素与复发性脑梗死的关系,用多元相关分析各危险因素间的相关性。结果复发性脑梗死组的吸烟史、糖尿病史、高血压病史、高脂血症史、TIA史、房颤史、Hhcy的比例明显高于初发性脑梗死组（P均〈0.05）。多元Logistic回归分析显示,糖尿病史（P=0.030）、TIA史（P=0.043）、房颤病史（P=0.016）和Hhcy（P=0.042）是复发性脑梗死的主要危险因素。多元相关分析显示该5项因素间没有相关性。结论糖尿病史、TIA史、房颤病史和Hhcy是复发性脑梗死的独立危险因素。     

糖尿病并发急性脑梗死的临床特点及近期预后分析

目的：对比分析糖尿病脑梗死与非糖尿病脑梗死患者的临床特点及近期预后。方法将同期住院的脑梗死患者按既往史分为糖尿病脑梗死128例及非糖尿病脑梗死234例,对比分析2组年龄及性别构成、发病时间等一般特征及出院时神经功能缺损改善率、住院病死率等近期预后情况。结果糖尿病脑梗死患者住院病死率高于非糖尿病脑梗死（P＜0·05）,临床神经缺损改善率有明显差别。结论脑梗死合并糖尿病患者住院病死率、临床神经功能缺损改善率和预后都差于无糖尿病脑梗死。     

进展性脑梗死相关危险因素分析

目的探寻引起脑梗死进展的相关危险因素。方法对我院2008年5月-2011年5月住院的急性脑梗死患者246例,根据入院后病情演变分为进展性脑梗死组(PCI)和非进展性脑梗死组(NPCI)。观察项目包括年龄、高血压史、糖尿病史、冠心病史、脑卒中病史、高脂血症史、吸烟史及饮酒史,入院时神经功能评分、入院时高血压、入院后血压降低、发热、血脂、血糖、红细胞压积、颈动脉狭窄及颅内动脉狭窄进行分析。结果 PCI组的糖尿病史、早期不适当降压治疗、颅内动脉狭窄、颈动脉狭窄、入院后24小时内最高体温、白细胞计数、空腹血糖及侧脑室旁梗死差异有显著统计学意义。结论糖尿病病史、早期不适当降压治疗、发热、白细胞计数增高、空腹血糖增高、劲内动脉和颅内动脉狭窄及侧脑室旁梗死是引起脑梗死进展的主要危险因素。     

短暂性脑缺血发作后缺血性脑卒中的危险因素

目的探讨TIA后缺血性脑卒中的危险因素。方法收集184例TIA患者的临床资料,分析TIA后缺血性脑卒中的危险因素。结果与无缺血性脑梗死组比较,缺血性脑梗死组高龄(≥60岁)、高血压、糖尿病以及有吸烟、饮酒史的比率显著升高(P0.05~0.01),性别及高血脂比率差异无统计学意义(均P0.05)。与无缺血性脑梗死组比较,缺血性脑梗死组发作时间≥30 min、发作次数≥3次、病程≥24 h(P0.05~0.01),而TIA类型差异无统计学意义(均P0.05)。Logistic回归分析显示,高龄、高血压、糖尿病以及吸烟、饮酒史与TIA进展为缺血性脑卒中呈正相关(OR=29.799,95%CI:2.189~405.569,P=0.011;OR=0.649,95%CI:0.038~6.850,P=0.005;OR=8.569,95%CI:1.314~55.862,P=0.025;OR=0.158,95%CI:0.025~0.980,P=0.048)。结论高龄、高血压、糖尿病、有吸烟饮酒史是TIA发展为缺血性脑卒中的独立危险因素。     

南京地区缺血性脑卒中二级预防中危险因素的调查分析

目的调查并分析南京地区缺血性脑卒中二级预防中的危险因素。方法现将2013年03月~2013年12月在南京脑科医院门诊就诊的有过脑梗死(CI)病史或期间有CI发病的患者886例(CI组)和头颅MRI显示仅有腔隙性脑梗死(LI)病灶但无卒中发作史的患者1247例(LI组)进行资料采集,包括性别、年龄、吸烟史、高血压、糖尿病、房颤史、心肌梗死史、外周动脉疾病、颅内外动脉狭窄情况及Essen卒中风险评分量表(ESRS)。同时收集南京汤山社区和南湖社区缺血性脑卒中中低危人群9739例(LR组)的相关数据,对三组数据进行分析比较。结果 CI组和LI组高血压、糖尿病比率显著高于LR组(均P0.01)。CI组颅内外动脉狭窄比率显著高于LI组(P0.01)。进一步将脑梗死的六个危险因素进行多元Logistic回归分析结果均无统计学意义。CI组与LI组ESRS风险分级比例之间比较无统计学差异。结论南京地区高血压、糖尿病是CI的常见危险因素。在缺血性脑卒中的危险因素中对颅内外动脉狭窄的监测更为重要。     

脑卒中患者早期康复疗效的影响因素分析及干预对策

目的：探讨脑卒中患者早期康复疗效的影响因素,并提出相应的干预对策。方法选取脑卒中患者173例,将其分为恢复良好者和康复不佳者,采用FM A和M BI量表对其早期康复治疗效果进行评价。结果恢复良好的患者中年龄＜60岁、体质量指数≤25 kg/m2、家庭年收入较高、学历较高、医保付费、开始治疗较早、脑损伤面积≤3 cm2、家庭支持良好者明显多于康复较差的患者,而合并高血压、糖尿病者以及脑卒中复发患者则明显少于康复较差的患者。2组比较差异有统计学意义（P＜0·05）。2组患者性别及脑卒中类型比较差异无统计学意义（P＞0·05）。患者的年龄、家庭年收入、学历、基础疾病、是否为复发性脑卒中、病程、脑组织损伤面积以及家庭支持情况是影响早期康复治疗效果的独立危险因素。结论脑卒中患者早期康复疗效受到多重因素的影响,应根据患者的情况设计个体化的治疗和护理方案,以改善患者的预后。     

新疆地区急性脑卒中患者相关危险因素多元回归分析

目的探讨新疆地区急性脑卒中的危险因素,为预防急性脑卒中的发生提供理论依据。方法收集新疆地区急性脑卒中779例作为病例组,同期非急性脑卒中726例作为对照组,采用回顾性脑卒中登记方法,并进行统计学分析。结果 （1）病例组与对照组logistic回归显示：性别（P=0.028,OR=1.384）,年龄（P=0.010,OR=1.014）,族别（P=0.014,OR=1.346）,饮酒（P〈0.001,OR=2.739）,脑卒中家族史（P〈0.001,OR=0.374）,糖尿病病史（P〈0.001,OR=2.093）,高血压病病史（P〈0.001,OR=5.713）,高脂血症（P=0.009,OR=0.656）均与急性脑卒中相关。（2）维吾尔族与汉族急性脑卒中危险因素比较：779例急性脑卒中,其在男女性别比例上无显著性差异。维吾尔族相比汉族脑卒中患者,其在吸烟、饮酒及糖尿病病史的比例要低于汉族（P〈0.05）,而患高血压病病史的比例高于汉族（P〈0.05）。结论性别、年龄、民族、饮酒、糖尿病病史、高血压病病史是新疆地区急性脑卒中的危险因素。     

精神障碍住院患者出院后1年内再住院的危险因素

目的 探讨精神科住院患者出院后1年内再住院的危险因素,为临床评估及干预提供参考.方法 通过电子病历系统,收集2013年-2017年在广州医科大学附属脑科医院住院患者的信息.对患者再入院的危险因素进行生存分析,使用COX风险回归并绘制生存曲线,使用多元线性回归对患者出院后1年内至再次入院的间隔天数的影响因素进行分析.结果...     

The effect of hospitalization on oral anticoagulation control: a population-based study

BACKGROUND: For patients taking oral anticoagulants (OAC), the proportion of time spent in the therapeutic range is strongly associated with bleeding and thromboembolic risk. Previous studies examining OAC control may not generalize because the patient population was select or INR capture was incomplete. OBJECTIVES: Measure OAC control for an entire population of elderly people and determine patient factors associated with OAC control. PATIENTS: People in Eastern Ontario without valve replacement aged 65 years or greater who were treated with warfarin between 1 September 1999 and 1 September 2000. DESIGN: Retrospective cohort study using population-based administrative databases. OAC control was measured as the proportion of days in therapeutic range (PDTR), defined as the number days with the INR between 2 and 3 divided by total number of days observation. Linear interpolation was used to determine INR levels between measures. Negative binomial regression was used to identify patient factors independently associated with PDTR. We also determined which factors were associated with proportion of days with a critically low (<1.5) or critically high (>/=5) INR. RESULTS: 7179 people were followed for a total of 3238 years. 15% of people were hospitalized during the study. Overall, PDTR was 59.2% (95% CI 59.1%-59.2%). Independent of all other significant factors, hospitalization was associated with a 15% decrease in the PDTR 15% (rate ratio 0.85, 95% CI 0.83-0.87). Hospitalization was also independently associated with greater proportion of time with a critically low INR (rate ratio 1.68, 95% CI 1.51-1.88) and a critically high INR (1.70, 95% CI 1.38-2.08). CONCLUSIONS: Elderly people in eastern Ontario taking warfarin were therapeutic 59.2% of the time. Independent of other patient factors, patients who are hospitalized have the greatest risk of poor anticoagulation control. Control for anticoagulated patients who get hospitalized should be reviewed to determine if and how it could be improved.     

A long-term follow-up study of adolescent psychiatric in-patients. Part II. Predictors of delinquency

A total of 932 adolescent psychiatric in-patients were followed up 15-33 years after hospitalization by record linkage to the National Register of Criminality. On the basis of the hospital records the patients were rediagnosed according to DSM-IV and scored on data postulated to be predictors of later delinquency. The factors were investigated by Kaplan-Meyer survival analysis and Cox regression. Cox analysis showed that, in males, main diagnosis (relative risk (RR)=2.9, 95% confidence interval (CI)=2.0-4.2), verbal abuse at home (RR=1.5, CI=1.1-2.0), disciplinary problems at school (RR=1.7, CI=1.2-2.5), and violating ward rules during hospitalization (RR=1.6, CI=1.2-2.2) were strong and independent predictors of delinquency. In females, main diagnosis (RR=2.6, CI=1.6-4.2), concurrent psychoactive substance use disorder (RR=2.9, CI=1.9-4.2), verbal abuse at home (RR=1.5, CI=1.0-2.1), and disciplinary problems at school (RR=1.6, CI=1.1-2.5) were strong and independent predictors of delinquency. Among males who violated ward rules and received a diagnosis of disruptive behaviour disorder, psychoactive substance use disorder or personality disorder at index hospitalization, as many as 77.6% had a criminal record at follow-up.     

A long-term follow-up study of adolescent psychiatric in-patients. Part IV. Predictors of a non-negative outcome

Fifteen years after first hospitalization 932 patients were followed up by record linkage to national registers of criminality, disability and causes of death. On the basis of hospital records, all patients were rediagnosed according to DSM-IV and scored on factors postulated to have predictive power with regard to a non-negative outcome, defined as having avoided entry into the above-mentioned registers at follow-up. Logistic regression showed that in males psychiatric diagnosis (odds ratio (OR)=2.4, 95% confidence interval (CI)=1.3-4.3), no psychoactive substance use (OR=3.2, CI=1.2-8.0), no disciplinary problems in school (OR=4.1, CI=2.4-6.9) and an IQ of > or = 90 (OR=1.9, CI=1.03-3.4) were strong and independent predictors of a non-negative outcome. In females, psychiatric diagnosis (OR=2.2, CI=1.3-3.6), no psychoactive substance use (OR=2.4, CI=1.5-3.8), DSM-IV GAF > or = 40 at admission (OR=2.9, CI=1.8-4.6) and an IQ of > or = 90 (OR=1.7, CI=1.01-2.8) were strong and independent predictors of a non-negative outcome. Only 5.1% of male patients with psychoactive substance use disorder and disciplinary problems in school had a non-negative outcome, while as many as 76.6% of female patients without psychoactive substance use and a DSM-IV GAF of > or = 40 at hospitalization had a non-negative outcome at 15 years follow-up.     

Patterns of psychiatric hospitalizations in schizophrenic psychoses within the Northern Finland 1966 Birth Cohort

We report patterns of hospitalization in schizophrenic psychoses by age 34 in a longitudinal population-based cohort. We test the predictive ability of various demographic and illness-related variables on patterns of hospitalization, with a special focus on the length of the first psychiatric hospitalization. All living subjects of the Northern Finland 1966 Birth Cohort with DSM-III-R schizophrenia (n=88) and other schizophrenia spectrum cases (n=27) by the year 1997 in the Finnish Hospital Discharge Register were followed for an average of 10.5 years. Measures of psychiatric hospitalization included time to re-hospitalization (as continuous and as re-hospitalization within 2 years) and the number of hospital episodes. Length of the first hospitalization, other illness-related and various socio-demographic predictors were used to predict hospitalization patterns. After adjusting for gender, age at first admission and number of hospital days a short (1-14 days) first hospitalization (reference >30 days; adjusted odds ratio 6.39; 95% CI 2.00-20.41) and familial risk of psychosis (OR 3.36; 1.09-10.39) predicted re-hospitalization within 2 years. A short first hospitalization also predicted frequent psychiatric admissions defined as the first three admissions within 3 years (OR 13.77; 3.92-48.36). A short first hospitalization was linked to increased risk of re-hospitalizations. Although short hospitalization is recommended by several guidelines, there may be a group of patients with schizophrenic psychoses in which too short a hospitalization may lead to inadequate treatment response.     

Venous thromboembolism in acutely ill hospitalized medical patients

Background

Acute and chronic illness, immobility, and procedural and pharmacologic interventions may predispose patients in the Internal Medicine Wards to venous thromboembolic disease (VTE). The purpose of this study was to determine the incidence of VTE in these patients.

Materials and Methods

A retrospective chart review of cohort of consecutive patients admitted to Internal Medicine wards in Spain between January 1st 2005 and December 31st 2007 was performed. For each patient, demographic data, risk factors for VTE and the diagnosis of VTE during hospitalization was recorded.

Results

We analyzed 1,567,659 patients, excluding 28,226 patients who had DVT or PE before admission, and 196,555 who were discharged in the first 48 hours. We identify 12,458 new diagnosed VTE events among 1,344,959 patients (incidence 0.93%) hospitalized more than two days. Hospitalized-acquired VTE risk factors were feminine gender (odds ratio [OR] 1.31; CI95% 1.26-1.35), age > 70 (OR 1.08 CI95% 1.04-1.13), acute infectious disease (OR 1.27 CI95% 1.17-1.38), acute respiratory disease (OR 1.23 CI95% 1.17-1.28), dementia (OR 1.22 CI95% 1.14-1.31), neoplasic disease (OR 2.29, CI95% 2.19-2.49), and hemiplegia (OR 1.49, CI95% 1.31-1.69).

Conclusions

The number of patients with VTE in an Internal Medicine ward is higher than expected. Several independent risk factors for VTE were identified. Based on the large number of patients who developed a VTE during hospitalization, our data add strength to the argument that VTE prevention should be high on the list of priorities when health care policies are being formed.     

A long-term follow-up study of adolescent psychiatric in-patients. Part III. Predictors of disability

A total of 1095 adolescent psychiatric in-patients were followed up 15-33 years after hospitalization by record linkage to the National Register of Disability Benefits. On the basis of hospital records, all patients were rediagnosed according to DSM-IV and scored on data postulated to have predictive power with regard to disability. The factors were investigated by Kaplan-Meyer survival analysis and Cox regression. A psychotic or organic disorder, low score on DSM-IV Axis V (GAF) and the use of psychotropic medication at hospitalization were among the strong predictors of later disability, as were low IQ, poor achievement at school, somatic disorders, and self-harming behaviour (all P < 0.01). Cox analysis showed that, of these, the following factors remained strong and independent predictors of disability: psychotic and organic disorders (relative risk (RR)=3.1, 95% confidence interval (CI)=2.4-4.0), IQ < 90 (RR=1.8, CI=1.5-2.3); and GAF < 30 (RR=1.9, CI=1.5-2.4). Former adolescent psychiatric in-patients with a psychotic or organic disorder had a very high risk of later disability (71-81%), whereas those with other psychiatric diagnoses, and with IQ > or = 90 and GAF > or = 30 at hospitalization, had a relatively low risk of disability (22-29%).     

Factors Associated With In-Hospital Mortality in Very Elderly Patients With Ischemic Stroke: A Cohort Study

IntroductionThe highest mortality rates associated with ischemic stroke occur in patients of advanced age. However, studies of factors that establish the increase in hospital mortality are scanty in this population.Material and MethodsEpidemiologic, clinical and laboratory data, etiology and ischemic stroke subtype and complications during hospitalization were analyzed in 195 patients aged 80 years or older. In attempt to associate prognostic factor with the in-hospital mortality during first 28 days from admission, the death and survivor groups were compared.ResultsAmong the 195 patients evaluated, the age was 85.3 ± 4.6 years with a mortality of 26.1%. Following the multivariate model, the factors associated with in-hospital mortality were: age (OR = 1.07, 95% CI = 1.00-1.20), the score less than or equal to 8 on Glasgow coma scale (OR = 22.87, 95% CI = 3.55-148.76), diabetes mellitus (OR = 3.40, 95% CI = 1.30-8.87), total anterior clinical subtype (OR = 5.15, 95% CI = 1.82-14.52) and infectious complications (OR = 8.38, 95% CI = 3.28-21.43).ConclusionsThe following risk factors were associated with a higher in-hospital mortality rate in patients over 79 years of age with ischemic stroke: older age, Glasgow coma score less than or equal to 8, total anterior circulation infarction, infection, and diabetes mellitus.