社区缺血性脑卒中患者遗留功能障碍现况及其影响因素

doi:10.3969/j.issn.1004-583X.2021.12.003

摘要/Abstract

摘要：

目的调查社区缺血性脑卒中患者遗留功能障碍现况并分析其影响因素。方法本研究纳入2020年5-9月就诊于石家庄市桃园、裕强、东苑社区卫生服务中心的缺血性脑卒中患者进行问卷调查,问卷由问卷星平台形成,并由社区一线全科医生收集患者一般资料及脑卒中相关资料,筛选脑卒中功能障碍相关影响因素。结果共纳入缺血性脑卒中患者232例,其中男性122例(52.6%),女性110例(47.4%);全部患者中有后遗症者99例(42.7%),多因素二元logistic回归分析结果提示血脂异常、冠心病、长期精神紧张、规律运动、脑卒中复发、血糖水平是否稳定为缺血性脑卒中患者出现后遗功能障碍的主要影响因素(P<0.05)。结论缺血性脑卒中患者血脂异常、冠心病、长期精神紧张、有过脑卒中复发为脑卒中遗留功能障碍的危险因素,规律运动、血糖水平稳定为保护因素,通过控制饮食、适当有氧运动以及药物干预使患者的血糖、血脂及体重控制在正常范围对于预防及减轻遗留功能障碍均有积极意义。

关键词: 缺血性卒中, 后遗症, 横断面研究, 影响因素分析

Abstract:

Objective To survey the situation of residual dysfunction of ischemic stroke (IS) in patients and its influencing factors in community. Methods This study included IS patients who admitted to the community health service centers in Shijiazhuang City ( Taoyuan Community, Yuqiang Community, Dongyuan Community) from May to September 2020. A questionnaire focusing on those target population were performed which supplied by the platform named “Wenjuanxing”. The general address data and stroke-related data was collected by general practitioners in the community, and to screen influencing factors for stroke-related residual dysfunction. Results There are 122 males (52.6%) and 110 females (47.4%) in out of involved 232 IS patients, of which 99 patients (42.7%) had sequelae. Multivariate logistic regression analysis suggested that the main influencing factors for stroke-related residual dysfunction were whether dyslipidemia, coronary heart disease, long-term mental stress, regular exercise, recurrence of stroke, and glucose stability (P<0.05). Conclusion For IS patients, the influencing factors for stroke-related residual dysfunction are dyslipidemia, coronary heart disease, long-term mental stress, recurrence of stroke; Protective factors for those was regular exercise and glucose stability. Proper diet, aerobic exercise and drug intervention is capable controlling patient's glycemia, blood lipids and weight in the normal range, which has positive significance in preventing and reducing stroke-related residual dysfunction.

Key words: ischemic stroke, sequelae, cross-sectional studies, risk factors

中图分类号:

R743.3

张琴, 王淑彬, 苏璇, 袁睿, 高萌晞, 国丽茹. 社区缺血性脑卒中患者遗留功能障碍现况及其影响因素[J]. 临床荟萃, 2021, 36(12): 1073-1078.

Zhang Qin, Wang Shubin, Su Xuan, Yuan Rui, Gao Mengxi, Guo Liru. Situation of ischemic stroke-related residual dysfunction in patients and its influencing factors in community[J]. Clinical Focus, 2021, 36(12): 1073-1078.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2021.12.003

https://huicui.hebmu.edu.cn/CN/Y2021/V36/I12/1073

图/表 2

表1 不同既往病史、服药情况、脑卒中家族史、生活习惯等缺血性脑卒中患者后遗症发生率的比较[例(%)]

项目	例数	脑卒中后遗症	χ²值	$P$ 值
高血压
有无	134 95	62(46.3) 35(36.8)	1.655	0.198
糖尿病
有无	66 163	35(53.0) 62(38.0)	3.733	0.053
血脂异常
有无	93 136	52(55.9) 45(33.1)	10.870	0.001
冠心病
有无	41 188	25(61.0) 72(38.3)	6.191	0.013
抗血小板药物
有无	107 122	49(45.8) 49(40.2)	0.526	0.468
抗凝药物
有无	26 203	18(69.2) 80(39.4)	7.199	0.007
降压药物
有无	134 95	67(50.0) 31(32.6)	6.159	0.013
降脂药物
有无	108 121	57(52.8) 41(33.9)	7.567	0.006
脑卒中复发
有无	81 147	57(70.4) 40(27.2)	38.051	0.000
脑血管病家族史
有无	66 161	31(47.0) 66(41.0)	0.461	0.497
冠心病家族史
有无	49 178	30(61.2) 67(37.6)	7.796	0.005
吸烟史
有无	48 184	29(60.4) 70(38.0)	6.902	0.009
饮酒史
有无	67 165	35(52.2) 64(38.8.)	2.996	0.083
长期精神紧张
有无	36 195	23(63.9) 75(38.5)	7.037	0.008
性格易激动
有无	46 185	26(56.5) 72(38.9)	3.980	0.046
爱吃高油高盐食物
有无	58 173	28(48.3) 70(40.5)	0.789	0.374
体力活动不足
有无	53 178	28(52.8) 70(39.3)	2.521	0.112
规律运动
有无	67 160	22(32.8) 76(47.5)	3.563	0.059
血糖水平
稳定不稳定	113 96	35(31.0) 52(54.2)	10.556	0.001

表1 不同既往病史、服药情况、脑卒中家族史、生活习惯等缺血性脑卒中患者后遗症发生率的比较[例(%)]

项目	例数	脑卒中后遗症	χ²值	$P$ 值
高血压
有无	134 95	62(46.3) 35(36.8)	1.655	0.198
糖尿病
有无	66 163	35(53.0) 62(38.0)	3.733	0.053
血脂异常
有无	93 136	52(55.9) 45(33.1)	10.870	0.001
冠心病
有无	41 188	25(61.0) 72(38.3)	6.191	0.013
抗血小板药物
有无	107 122	49(45.8) 49(40.2)	0.526	0.468
抗凝药物
有无	26 203	18(69.2) 80(39.4)	7.199	0.007
降压药物
有无	134 95	67(50.0) 31(32.6)	6.159	0.013
降脂药物
有无	108 121	57(52.8) 41(33.9)	7.567	0.006
脑卒中复发
有无	81 147	57(70.4) 40(27.2)	38.051	0.000
脑血管病家族史
有无	66 161	31(47.0) 66(41.0)	0.461	0.497
冠心病家族史
有无	49 178	30(61.2) 67(37.6)	7.796	0.005
吸烟史
有无	48 184	29(60.4) 70(38.0)	6.902	0.009
饮酒史
有无	67 165	35(52.2) 64(38.8.)	2.996	0.083
长期精神紧张
有无	36 195	23(63.9) 75(38.5)	7.037	0.008
性格易激动
有无	46 185	26(56.5) 72(38.9)	3.980	0.046
爱吃高油高盐食物
有无	58 173	28(48.3) 70(40.5)	0.789	0.374
体力活动不足
有无	53 178	28(52.8) 70(39.3)	2.521	0.112
规律运动
有无	67 160	22(32.8) 76(47.5)	3.563	0.059
血糖水平
稳定不稳定	113 96	35(31.0) 52(54.2)	10.556	0.001

表2 缺血性脑卒中患者后遗症情况影响因素的多因素二元logistic回归分析结果

变量(赋值)	回归系数	标准误	Wald χ²值	$P$ 值	$OR$ 值	95% $CI$
变量(赋值)	回归系数	标准误	Wald χ²值	$P$ 值	$OR$ 值	下限	上限
糖尿病(1)	0.354	0.392	0.813	0.367	1.424	0.660	3.072
血脂异常(1)	0.944	0.431	4.786	0.029	2.569	1.103	5.984
冠心病(1)	1.21	0.477	6.427	0.011	3.352	1.316	8.540
服用抗凝药物(1)	0.648	0.567	1.306	0.253	1.912	0.629	5.815
服用降压药物(1)	0.523	0.344	2.313	0.128	1.687	0.860	3.310
服用降血脂药物(1)	-0.008	0.428	0.000	0.985	0.992	0.428	2.297
吸烟史(1)	0.356	0.405	0.772	0.38	1.428	0.645	3.159
长期精神紧张(1)	1.124	0.477	5.541	0.019	3.077	1.207	7.843
血糖水平稳定(1)	-0.832	0.359	5.38	0.02	0.435	0.215	0.879
规律运动(1)	-0.792	0.368	4.622	0.032	0.453	0.220	0.932
脑卒中复发(1)	0.354	0.392	0.813	0.367	1.424	0.660	3.072

表2 缺血性脑卒中患者后遗症情况影响因素的多因素二元logistic回归分析结果

变量(赋值)	回归系数	标准误	Wald χ²值	$P$ 值	$OR$ 值	95% $CI$
变量(赋值)	回归系数	标准误	Wald χ²值	$P$ 值	$OR$ 值	下限	上限
糖尿病(1)	0.354	0.392	0.813	0.367	1.424	0.660	3.072
血脂异常(1)	0.944	0.431	4.786	0.029	2.569	1.103	5.984
冠心病(1)	1.21	0.477	6.427	0.011	3.352	1.316	8.540
服用抗凝药物(1)	0.648	0.567	1.306	0.253	1.912	0.629	5.815
服用降压药物(1)	0.523	0.344	2.313	0.128	1.687	0.860	3.310
服用降血脂药物(1)	-0.008	0.428	0.000	0.985	0.992	0.428	2.297
吸烟史(1)	0.356	0.405	0.772	0.38	1.428	0.645	3.159
长期精神紧张(1)	1.124	0.477	5.541	0.019	3.077	1.207	7.843
血糖水平稳定(1)	-0.832	0.359	5.38	0.02	0.435	0.215	0.879
规律运动(1)	-0.792	0.368	4.622	0.032	0.453	0.220	0.932
脑卒中复发(1)	0.354	0.392	0.813	0.367	1.424	0.660	3.072

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