神经功能缺损评分与高血压脑出血老年患者心脏事件的关系

目的探讨神经功能缺损评分(NIHSS评分)与高血压脑出血老年患者心脏事件的关系。方法选取90例高血压脑出血老年患者为研究对象,根据住院期间是否发生心脏事件分为发生组26例与未发生组64例,比较2组患者临床特征的差异,同时分析NIHSS评分与心脏事件发生的相关性,并采用ROC曲线分析NIHSS评分对不良心脏事件发生的预测价值。结果90例高血压脑出血老年患者中26例(28.9%)发生心脏不良事件(发生组),其中急性冠脉综合征12例(13.3%),有症状的心律失常4例(4.4%),心脏骤停1例(1.1%),急性心力衰竭8例(8.9%),死亡1例(1.1%);64例(71.1%)未发生心脏不良事件(未发生组)。2组年龄、出血部位、脑出血量、BNP、CK、cTnT水平比较差异有统计学意义(P<0.05);其余资料比较无显著性差异(P>0.05)。Logistic多因素分析显示,高龄、NIHSS评分高、脑出血部位(基底节、丘脑)、脑出血量多、CK水平高是高血压脑出血老年患者发生心脏事件的独立危险因素(P<0.05)。入院后2组NIHSS评分均逐渐升高,入院后48 h达最高峰,发生组持续至入院后72 h,入院后7 d NIHSS评分降低(P<0.05);未发生组入院后72 h明显降低(P<0.05)。从入院时到入院后7 d,发生组NIHSS评分均高于未发生组(P<0.05)。入院后48 h NIHSS评分的AUC面积>0.7,灵敏度、特异度分别为81.6%、84.2%,高于各项指标其他时间段(P<0.05)。结论高血压脑出血老年患者心脏事件发生受多种因素影响,随NIHSS评分增高发生风险越大,临床上对入院后48 h NIHSS评分>15.67分的患者需引起重视,其心脏事件发生风险较大。

Relationship between neurological deficit score and cardiac events in elderly patients with hypertensive cerebral hemorrhage

Objective To investigate the relationship between neural function defect scale(NIHSS score)and cardiac events in elderly patients with hypertensive cerebral hemorrhage.Methods Ninety elderly patients with hypertensive intracerebral hemor?rhage were selected as the research objects.According to whether a cardiac event occurred during hospitalization,they were divided in?to 26 cases in the occurring group and 64 cases in the non-occurring group.And the ROC curve was used to analyze the predictive value of NIHSS score on the occurrence of adverse cardiac events.Results Among the 90 elderly patients with hypertensive intrace?rebral hemorrhage,26 cases(28.9%)had adverse cardiac events(occurrence group),including 12(13.3%)cases of acute coronary syndrome,4(4.4%)cases of symptomatic arrhythmia,1(1.1%)case of cardiac arrest,8(8.9%)cases of acute heart failure,and 1(1.1%)case of death.Sixty-four cases(71.1%)did not occur(non-occurrence group).There were significant differences in age,bleeding site,amount of cerebral hemorrhage,BNP,CK and cTnT levels between the two groups(P<0.05).There was no significant difference in other data(P>0.05).Logistic multivariate analysis showed that advanced age,high NIHSS score,cerebral hemorrhage site(basal ganglia,thalamus),large amount of cerebral hemorrhage,and high CK level were independent risk factors for cardiac events in elderly patients with HICH(P<0.05).NIHSS scores in both groups increased gradually after admission,and reached the peak 48h after admission,and the NIHSS scores in the developing group continued to 72h after admission,and decreased 7d after ad?mission(P<0.05).It was significantly decreased 72h after admission in the non-developed group(P<0.05).From admission to 7d after admission,the NIHSS scores of the patients with the disease were higher than those of the patients without the disease(P<0.05).The AUC area of NIHSS score at 48h after admission was>0.7,and the sensitivity and specificity were 81.6%and 84.2%,respective?ly,which were higher than the sensitivity and specificity of other indicators at other time periods(P<0.05).Conclusion The occur?rence of cardiac events in elderly patients with hypertensive intracerebral hemorrhage is affected by a variety of factors.With the in?crease of the NIHSS score,the greater the risk of occurrence,clinical attention should be paid to patients with a NIHSS score>15.6748h after admission,and the risk of cardiac events is greater.