CAJ | 학술논문

目的发现与急性缺血性脑卒中早期神经功能恶化(END)相关的复合危险因素,提高预测和预防急性缺血性脑卒中END的能力.方法选取自2009年10月至2012年12月青岛市市立医院收治的脑梗死患者558例,其中符合急性缺血性脑卒中END诊断标准的患者107例,符合急性缺血性脑卒中早期神经功能无恶化诊断标准的患者451例.筛选神经功能评分等9类58项相关因素变量,采用关联规则挖掘方法分析各项危险因素及其集合与急性缺血性脑卒中END之间的关联关系.结果关联规则挖掘结果发现,与急性缺血性脑卒中END关联度较高的单项危险因素有2项,二项因素集合有3项、三项因素集合有7项、四项因素集合有15项,复合因素越多,END的概率越高.复合因素的集合多以不同类别的因素变量之间的组合为主,涉及到神经功能评分、感染情况、吞咽困难、个人生活史(吸烟、饮酒)、梗死部位、年龄、电解质、C反应蛋白、同型半胱氨酸等.独立危险因素中除了文献常见报道的,本研究还发现入院时的心率以及发病到住院的时间间隔也与急性缺血性脑卒中END具有较强的关联关系.结论急性缺血性脑卒中END的发生可能是多种因素集合共同作用的结果;预防END时,应综合考虑所有的危险因素,采取多种针对性的措施.
목적 발현여급성결혈성뇌졸중조기신경공능악화(END)상관적복합위험인소,제고예측화예방급성결혈성뇌졸중END적능력.방법 선취자2009년10월지2012년12월청도시시립의원수치적뇌경사환자558례,기중부합급성결혈성뇌졸중END진단표준적환자107례,부합급성결혈성뇌졸중조기신경공능무악화진단표준적환자451례.사선신경공능평분등9류58항상관인소변량,채용관련규칙알굴방법분석각항위험인소급기집합여급성결혈성뇌졸중END지간적관련관계.결과 관련규칙알굴결과발현,여급성결혈성뇌졸중END관련도교고적단항위험인소유2항,이항인소집합유3항、삼항인소집합유7항、사항인소집합유15항,복합인소월다,END적개솔월고.복합인소적집합다이불동유별적인소변량지간적조합위주,섭급도신경공능평분、감염정황、탄인곤난、개인생활사(흡연、음주)、경사부위、년령、전해질、C반응단백、동형반광안산등.독립위험인소중제료문헌상견보도적,본연구환발현입원시적심솔이급발병도주원적시간간격야여급성결혈성뇌졸중END구유교강적관련관계.결론 급성결혈성뇌졸중END적발생가능시다충인소집합공동작용적결과;예방END시,응종합고필소유적위험인소,채취다충침대성적조시.
Objective To find out the composite risk factors associated with early neurological deterioration (END) in acute ischemic stroke,to reveal the mechanism of END,and to provide the data base for the early prediction and prevention.Methods Five hundred and fifty-eight patients with cerebral infarction admitted to our hospital from October 2009 to December 2012,were screened.Among them,107 patients met the diagnostic criteria of END in acute ischemic stroke,451 patients met the diagnostic standard of early acute ischemic stroke without END.Neurological function scale and other variables included 58 related factors of 9 categories were selected.Association rule mining methods were used to analyze relations between END in acute ischemic stroke and risk factors sets.Results The results of association rule mining discovered that there were 2 individual risk factors,3 double-factor combinations,7 triple-factor combinations and 15 four-factor combinations related with END in the early stage of acute ischemic stroke;the more the composite factors,the higher the probability of neurological deterioration;the composite factors were mostly the combination of variables of different categories,involving neurological function scale scores,infection condition,dysphagia,personal life history (smoking and drinking),infarction location,age,and levels of electrolyte,C reactive protein,and homocysteine.Besides some independent risk factors which had been reported in the literatures,the results of this study found that heart rate and time interval from onset to hospitalization also related with END in early acute ischemic stroke.Conclusion END in acute ischemic stroke may be attributed to the combination effect of variable factors;all risk factors should be considered and a variety of targeted measures should be taken to prevent and treat the patients with END in early acute ischemic stroke.