中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2011年
12期
826-831
,共6页
郝子龙%刘鸣%李伟%谭燕%张月辉%吴丽娥%赵晓玲%杨杰%王清芳%谈颂%阳清伟%吴波%王丽春
郝子龍%劉鳴%李偉%譚燕%張月輝%吳麗娥%趙曉玲%楊傑%王清芳%談頌%暘清偉%吳波%王麗春
학자룡%류명%리위%담연%장월휘%오려아%조효령%양걸%왕청방%담송%양청위%오파%왕려춘
卒中%登记%前瞻性研究
卒中%登記%前瞻性研究
졸중%등기%전첨성연구
Stroke%Registries%Prospective studies
目的 探讨卒中登记方法、了解卒中患者基本特征和功能结局.方法 前瞻性、连续性登记自2002年3月1日起在四川大学华西医院神经内科住院的卒中患者.由统一培训的专科医师填写卒中登记表,登记患者临床特点、住院诊治情况,并随访各时点结局(发病后7d,1、3、6和12个月末的死亡和残疾).结果 纳入自2002年3月1日至2006年8月31日连续性登记的卒中患者共3123例.其中65.5％来自城区,34.5％来自农村.年龄14～98(63.05±17.98)岁,男性占60.3％,住院期间完成头颅CT和(或)MRI者占97％(3028/3123).2002年3月至2004年9月纳入各类卒中患者共1804例.其中缺血性卒中62.1％ (1120/1804),脑出血 28.4％(513/1804),蛛网膜下腔出血4.0％ (72/1804),TIA 5.5％ (99/1804).2004年10月后未纳入蛛网膜下腔出血和TIA患者.入院时中位NIHSS评分脑出血患者8(3 ～ 15)分,脑梗死5(2 ～10)分.糖尿病(OR=2.427,95％ CI1.811 ～3.253,P=0.000)、房颤(OR =6.121,95％ CI3.535 ～ 10.60,P=0.000)、冠心病(OR=4.144,95％ CI2.944～5.832,P=0.000)、TIA史(OR =4.342,95％ CI1.726 ～ 10.92,P=0.001)发生比例脑梗死组高于脑出血组,而饮酒史脑梗死组低于脑出血组(OR=0.740,95％ CI0.611 ～0.896,P=0.002).缺血性卒中患者溶栓占0.9％(20例),抗血小板治疗83.0％,甘露醇23.5％,神经保护剂(胞二磷胆碱)68.1％,中成药89.7％.7d和1个月病死率脑出血组分别为10.7％和13.9％,脑梗死组分别为3.0％和5.2％.3、6及12个月死亡或残疾率脑出血组分别为40.4％、40.3％和38.9％；脑梗死组分别为37.1％、35.0％和33.4％.结论 本研究是国内目前报告的最大样本、最长时间的前瞻性连续性单中心卒中登记项目,提供了深入研究卒中临床特点的重要平台；本组患者病情偏轻,近期病死率及远期病死或残疾率低于国外,中国卒中防治的干预性临床试验设计应注意考虑这些特点.
目的 探討卒中登記方法、瞭解卒中患者基本特徵和功能結跼.方法 前瞻性、連續性登記自2002年3月1日起在四川大學華西醫院神經內科住院的卒中患者.由統一培訓的專科醫師填寫卒中登記錶,登記患者臨床特點、住院診治情況,併隨訪各時點結跼(髮病後7d,1、3、6和12箇月末的死亡和殘疾).結果 納入自2002年3月1日至2006年8月31日連續性登記的卒中患者共3123例.其中65.5％來自城區,34.5％來自農村.年齡14～98(63.05±17.98)歲,男性佔60.3％,住院期間完成頭顱CT和(或)MRI者佔97％(3028/3123).2002年3月至2004年9月納入各類卒中患者共1804例.其中缺血性卒中62.1％ (1120/1804),腦齣血 28.4％(513/1804),蛛網膜下腔齣血4.0％ (72/1804),TIA 5.5％ (99/1804).2004年10月後未納入蛛網膜下腔齣血和TIA患者.入院時中位NIHSS評分腦齣血患者8(3 ～ 15)分,腦梗死5(2 ～10)分.糖尿病(OR=2.427,95％ CI1.811 ～3.253,P=0.000)、房顫(OR =6.121,95％ CI3.535 ～ 10.60,P=0.000)、冠心病(OR=4.144,95％ CI2.944～5.832,P=0.000)、TIA史(OR =4.342,95％ CI1.726 ～ 10.92,P=0.001)髮生比例腦梗死組高于腦齣血組,而飲酒史腦梗死組低于腦齣血組(OR=0.740,95％ CI0.611 ～0.896,P=0.002).缺血性卒中患者溶栓佔0.9％(20例),抗血小闆治療83.0％,甘露醇23.5％,神經保護劑(胞二燐膽堿)68.1％,中成藥89.7％.7d和1箇月病死率腦齣血組分彆為10.7％和13.9％,腦梗死組分彆為3.0％和5.2％.3、6及12箇月死亡或殘疾率腦齣血組分彆為40.4％、40.3％和38.9％；腦梗死組分彆為37.1％、35.0％和33.4％.結論 本研究是國內目前報告的最大樣本、最長時間的前瞻性連續性單中心卒中登記項目,提供瞭深入研究卒中臨床特點的重要平檯；本組患者病情偏輕,近期病死率及遠期病死或殘疾率低于國外,中國卒中防治的榦預性臨床試驗設計應註意攷慮這些特點.
목적 탐토졸중등기방법、료해졸중환자기본특정화공능결국.방법 전첨성、련속성등기자2002년3월1일기재사천대학화서의원신경내과주원적졸중환자.유통일배훈적전과의사전사졸중등기표,등기환자림상특점、주원진치정황,병수방각시점결국(발병후7d,1、3、6화12개월말적사망화잔질).결과 납입자2002년3월1일지2006년8월31일련속성등기적졸중환자공3123례.기중65.5％래자성구,34.5％래자농촌.년령14～98(63.05±17.98)세,남성점60.3％,주원기간완성두로CT화(혹)MRI자점97％(3028/3123).2002년3월지2004년9월납입각류졸중환자공1804례.기중결혈성졸중62.1％ (1120/1804),뇌출혈 28.4％(513/1804),주망막하강출혈4.0％ (72/1804),TIA 5.5％ (99/1804).2004년10월후미납입주망막하강출혈화TIA환자.입원시중위NIHSS평분뇌출혈환자8(3 ～ 15)분,뇌경사5(2 ～10)분.당뇨병(OR=2.427,95％ CI1.811 ～3.253,P=0.000)、방전(OR =6.121,95％ CI3.535 ～ 10.60,P=0.000)、관심병(OR=4.144,95％ CI2.944～5.832,P=0.000)、TIA사(OR =4.342,95％ CI1.726 ～ 10.92,P=0.001)발생비례뇌경사조고우뇌출혈조,이음주사뇌경사조저우뇌출혈조(OR=0.740,95％ CI0.611 ～0.896,P=0.002).결혈성졸중환자용전점0.9％(20례),항혈소판치료83.0％,감로순23.5％,신경보호제(포이린담감)68.1％,중성약89.7％.7d화1개월병사솔뇌출혈조분별위10.7％화13.9％,뇌경사조분별위3.0％화5.2％.3、6급12개월사망혹잔질솔뇌출혈조분별위40.4％、40.3％화38.9％；뇌경사조분별위37.1％、35.0％화33.4％.결론 본연구시국내목전보고적최대양본、최장시간적전첨성련속성단중심졸중등기항목,제공료심입연구졸중림상특점적중요평태；본조환자병정편경,근기병사솔급원기병사혹잔질솔저우국외,중국졸중방치적간예성림상시험설계응주의고필저사특점.
Objective To analyze basic data and outcomes in Chengdu Stroke Registry.Methods The stroke patients consecutively admitted to Department of Neurology,West China Hospital,Sichuan University since March 1,2002 were prospectively registered.The baseline demographic,risk factors,treatment,and outcome data was recorded with standardized stroke register form by trained specialists.The patients were followed up at seven days,one,three,six months and one year after onset of the stroke for death and disability.Results A total of 3123 consecutive patients were registered between March 1,2002 and August 31,2006,of which 65.5％ came from urban areas and 34.5％ from rural areas.The age was (63.05 ± 17.98) years old and male accounted for 60.3％.Ninety-seven percent (3028/3123) of patients completed CT or MRI scanning during hospitalization.A total of 1804 patients were included between March 2002 and September 2004,of which ischemic stroke accounted for 62.1％ (1120/1804),intracranial hemorrhage 28.4％ (513/1804),subarachnoid hemorrhage 4.0％ (72/1804) and TIA 5.5％ (99/1804).The median NIHSS score on admission was 8(3-15) points in patients with cerebral hemorrhage,and 5(2-10) points in patients with ischemic stroke.Compared with the patients with intracranial hemorrhage,patients with ischemic stroke more frequently had a history of diabetes (OR =2.427,95％ CI 1.811- 3.253,P=0.000),atrial fibrillation (OR=6.121,95％ CI3.535-10.60,P=0.000),coronary heart disease (OR=4.144,95％ CI 2.944-5.832,P =0.000) and TIA (OR=4.342,95％ CI 1.726-10.92,P =0.001 ),and less alcohol consumption ( OR =0.740,95％ CI 0.611-0.896,P =0.002 ).The proportion of in-hospital treatments were thrombolysis 0.9％,anti-platelet therapy 83.0％,mannitol 23.5％,neuroprotective agents (citicoline) 68.1％,and Chinese herbal medicine 89.7％.Case fatality rate was 10.7％ and 13.9％ respectively at 7 days and one month for patients with intracranial hemorrhage,3.0％ and 5.2％ respectively for ischemic stroke.Death or disability was 40.4％,40.3％ and 38.9％ in patients with intracranial hemorrhage and 37.1％,35.0％ and 33.4％ for ischemic stroke at the end of 3,6,12 months respectively.Conclusions Our stroke registry is featured with the largest sample,and the longest period of consecutively registration.It provides an important platform for clinical investigation of stroke.Our study suggested case fatality and disability is lower in this group than in other ethics.Above features should be considered in design of future clinical trials in China.
