卒中后便秘对急性缺血性脑卒中患者预后的影响

目的：分析卒中后便秘发生率及危险因素,并探讨便秘对急性缺血性卒中患者预后的影响。方法：收集发病7d以内的首发缺血性脑卒中患者,记录包括各种危险因素在内的病史、体征以及12周内的死亡率等。发病1、4周均用美国国立卫生院卒中评分（NIHSS）行神经功能评定,用Barthel生活指数（BI）和改良的Rankin量表（MRS）行日常生活能力评定,并于12周时再次测评BI、MRS。便秘的评定方法依据罗马Ⅱ标准。采用4周及12周时的NIHSS、BI及MRS和12周内的死亡率作为评价患者病情严重程度和预后的主要指标。结果：入选的122例患者发生便秘63例（51.6%）。发病1周时便秘组NIHSS、MRS和BI分别为（10.05±6.38）、（4.10±0.84）和（38.41±23.64）分,与非便秘组的（4.36±4.34）、（3.12±0.79）和（70.25±20.01）分比较,差异均有统计学意义（P〈0.001）;经协方差分析后,便秘组4周NIHSS、MRS评分改善程度及12周MRS评分改善程度均低于非便秘组（P〈0.05或P〈0.001）,差异均有统计学意义;发病12周时便秘组、非便秘组的死亡率分别为8%、2%,但差异无统计学意义（P=0.240）。Logistic回归分析发现发病1周时BI是影响患者发生便秘的因素（P〈0.001）。结论：急性缺血性脑卒中患者便秘发生率较高,发病1周时的日常生活能力状况是主要影响因素;卒中后便秘可能导致患者的神经功能恢复差,遗留病残程度重。

Influence of Constipation after Stroke on the Prognosis of Patients with Acute Ischemic Stroke

Objective To investigate the incidence and risk factors of constipation in the patients with acute ischemic stroke and to analyze their effects on the prognosis. Methods Acute isehemic stroke patients hospitalized in the hospital within 7 days were recruited in the study and records including case histories, vital signs and death rate within 12 weeks were made. National Institutes of Health Stroke Scale （NIHSS）, Barthel Index （BI） and Modified Rankin Scale （MRS） were recorded at the 1st week and 4th week after stroke to evaluate the neurological function and ability of dependent life. BI and MRS were recorded at the 12th week after stroke. Roman Standard II was adopt to define constipation and NIHSS, BI and MRS of 4th week and 12th week and death rate within 12 weeks were adopted as main indexes to evaluate the illness and prognosis. Results 63 of 112 patients had constipation. The patients with constipation at the 1st week had higher NIHSS and MRS and lower BI than patients without constipation （P〈0.001,respeetively）, which had statistic significance. The improving degree of NIHSS and MRS at 4th week and MRS at 12th week in the patients with constipation were lower than those in the patients without constipation after analysis of eovarianee （P〈0.05 or P〈0.001, respectively）. The death rate within 12 weeks in the patients with constipation was higher than those without constipation （8% vs 2%）, but the difference was not statistically significant （P=0.240）. Logistic regression showed that the incidence of constipation was strongly related to BI of 1st week （P〈0.001）. Conclusion Patients with acute ischemie stroke have higher incidence of constipation and daily life ability within one week after stroke is the main influencing factor. Constipation after stroke may lead to poorer neurological function and more serious commemorative sign.