復發性腦梗塞之危險因子與預後分析

Analysis of Prognosis and Risk Factors of Recurrent Ischemic Stroke

目的：過去研究指出每年中風人數約有近三成屬復發。而復發性腦梗塞的後遺症及肢體殘障度往往比初次嚴重，且具較高致死率。因此本研究擬針對復發腦梗塞之危險因子與預後之分析。方法：本研究採回溯性方式，收集台灣南部某醫學中心自2009年1月至2010年12月共2年間，有完整紀錄缺血性腦梗塞住院患者為對象。收集基本資料包含中風類型、危險因子、吸菸喝酒習慣、發病時間、血液影像檢查報告及住院時和出院時的追蹤結果。中風型態，依照TOAST準則分成小血管阻塞、大動脈動脈硬化、心臟來源的栓塞、其他確定原因、未知原因所造成。並使用NIHSS及巴氏量表等二種量表追蹤評估預後。以單變項及多變項邏輯式迴歸分析探討復發腦梗塞之危險因子。結果：本研究樣本數有2,175人，其中屬復發性腦梗塞有552人 (25%)。有腦梗塞病史者，以高齡者較多（65歲以上占67%），其合併有高血壓、糖尿病、血脂異常、心臟病史、近期感染、尿毒症者之比例亦相對較高( p<0.05)，但有喝酒習慣之比例則較低。比較NIHSS分數，無論入院時或出院時在復發腦梗塞組均較高，而巴氏量表分級屬完全依賴(BI≤20)及嚴重依賴(21

Background: Sequelae and physical disabilities associated with recurrent strokes are often more severe and exhibit higher mortality than initial occurrences. Therefore, we aim to analyze the risk factors and prognosis associated with recurrent ischemic stroke. Methods: This retrospective study collected data from patients who suffered from stroke and had complete records from January 1, 2009 to December 31, 2010. We used the National Institute of Health Stroke Scale (NIHSS) and the Barthel Index (BI) to assess stroke prognosis. Recurrent cerebral infarction risk factors were investigated with univariate and multiple logical regression analysis. Results: In total, 2,175 patients were included in our study, including 552 (25%) with recurrent cerebral infarctions. Most recurrent infarctions occurred in patients ＞65 years of age (~67%). Patients with hypertension, history of smoking, heart disease, recent infection, and uremia had higher risks of recurrent stroke. Higher NIHSS scores were present in those either hospitalized or discharged who had history of cerebral infarction. There were a higher proportion with the Barthel Index classified into complete dependence (BI ≤ 20) and severe dependence (21 ＜ BI ≤ 60). Multiple logistic regression analysis showed hypertension, smoking, history of heart disease, recent infection, and uremia were independent risk factors for recurrent cerebral infarctions. Alcohol consumption was also a protective factor. Conclusion: The study found that hypertension, smoking, history of heart disease, recent infection, and uremia increased the risk of recurrent stroke. Reducing risk factors and managing these chronic diseases were the most effective stroke prevention strategies.