Department of Neurology, National Hospital Organization, Minami Kyoto Hospital, Kyoto, Japan.
Emerg Med J. 2013 Sep;30(9):728-31. doi: 10.1136/emermed-2012-201586. Epub 2012 Sep 27.
To predict the outcome of stroke at an acute stage is important but still difficult. Vomiting is one of the commonest symptoms in stroke patients. The aim of this study is threefold: first, to examine the percentage of vomiting in each of the three major categories of strokes; second, to investigate the association between vomiting and other characteristics and third, to determine the correlation between vomiting and mortality.
We investigated the existence or absence of vomiting in stroke patients in the Kyoto prefecture cohort. We compared the characteristics of patients with and without vomiting. We calculated the HR for death in both types of patients, adjusted for age, sex, blood pressure, arrhythmia, tobacco and alcohol use and paresis.
Of the 1968 confirmed stroke patients, 1349 (68.5%) had cerebral infarction (CI), 459 (23.3%) had cerebral haemorrhage (CH) and 152 (7.7%) had subarachnoid haemorrhage (SAH). Vomiting was seen in 14.5% of all stroke patients. When subdivided according to stroke type, vomiting was observed in 8.7% of CI, 23.7% of CH and 36.8% of SAH cases. HR for death and 95% CI were 5.06 and 3.26 to 7.84 (p<0.001) when all stroke patients were considered, 5.27 and 2.56 to 10.83 (p<0.001) in CI, 2.82 and 1.33 to 5.99 (p=0.007) in CH and 5.07 and 1.87 to 13.76 (p=0.001) in SAH.
Compared with patients without vomiting, the risk of death was significantly higher in patients with vomiting at the onset of stroke. Vomiting should be an early predictor of the outcome.
在急性阶段预测中风的结果很重要，但仍然很困难。呕吐是中风患者最常见的症状之一。本研究的目的有三：首先，检查三种主要类型中风患者的呕吐百分比；其次，研究呕吐与其他特征之间的关系，第三，确定呕吐与死亡率之间的相关性。
我们调查了京都地区队列中风患者中呕吐的存在与否。我们比较了有呕吐和无呕吐的患者的特征。我们计算了两种类型患者的死亡 HR，并调整了年龄、性别、血压、心律失常、吸烟和饮酒以及瘫痪等因素。
在 1968 名确诊的中风患者中，1349 名（68.5%）患有脑梗死（CI），459 名（23.3%）患有脑出血（CH），152 名（7.7%）患有蛛网膜下腔出血（SAH）。所有中风患者中有 14.5%出现呕吐。根据中风类型进一步细分，CI 患者中有 8.7%出现呕吐，CH 患者中有 23.7%，SAH 患者中有 36.8%。当考虑所有中风患者时，死亡的 HR 和 95%CI 为 5.06 和 3.26 至 7.84（p<0.001），CI 患者为 5.27 和 2.56 至 10.83（p<0.001），CH 患者为 2.82 和 1.33 至 5.99（p=0.007），SAH 患者为 5.07 和 1.87 至 13.76（p=0.001）。
与无呕吐的患者相比，发病时伴有呕吐的患者死亡风险显著升高。呕吐应作为早期预后指标。
