短暂性脑缺血发作患者的早期住院治疗：一项前瞻性、基于人群的研究。

Early hospitalization of patients with TIA: a prospective, population-based study.

机构信息

Department of Neurology, University of Lübeck, Lübeck, Germany.

出版信息

J Stroke Cerebrovasc Dis. 2014 Jan;23(1):99-105. doi: 10.1016/j.jstrokecerebrovasdis.2012.10.001. Epub 2012 Nov 16.

DOI:10.1016/j.jstrokecerebrovasdis.2012.10.001

PMID:23164482

Abstract

BACKGROUND

The German Stroke Society (GSS) recommends early hospitalization of patients with transient ischemic attack (TIA) regardless of ABCD(2) score. This population-based study determined the rate of stroke during hospitalization and within 3 months after discharge, as well as the rates of mortality and readmission during the 3 months after discharge in patients with TIA.

METHODS

During a 36-month period (starting November 2007), 2200 consecutive patients (mean age, 70.6 ± 12.8 years; 49% women) with TIA from 15 hospitals in the Federal State of Schleswig-Holstein (1 of the 16 states in Germany) were prospectively evaluated during hospitalization and a follow-up time of 3 months after discharge. The primary outcomes were stroke during hospitalization and 3 months after discharge, as well as readmission and mortality at 3 months. Odds ratios (ORs) were calculated by the adjusted logistic regression analysis.

RESULTS

Of 2200 patients (median time of admission, 6 hours from symptom onset), 24 patients (1.1%; 95% confidence interval [CI], 0.7%-1.5%) experienced a stroke during hospitalization (mean, 6 days), and of 1335 patients, 38 (2.8%; 95% CI, 2.1%-3.8%) experienced a stroke during the 3 months after discharge. Stroke during hospitalization was independently correlated with male sex (OR, 3.5) and acute brain infarction detected by brain imaging (OR, 2.6), whereas stroke within 3 months correlated with age greater than 65 years (OR, 3.0). The readmission rate (11.1%; 95% CI, 9.3%-12.7%) was increased in patients who had had previous stroke (OR, 1.7) but decreased in patients who were discharged with statin medication (OR, 0.6). The 3-month mortality (1.4%; 95% CI, 0.9%-1.9%) was independently correlated with unilateral weakness (OR, 2.6) and atrial fibrillation (AF) (OR, 2.6).

CONCLUSIONS

These findings may help clinicians to estimate the TIA prognosis in patients who were hospitalized early with TIA.

摘要

背景

德国卒中学会（GSS）建议无论 ABCD(2) 评分如何，都应尽早将短暂性脑缺血发作（TIA）患者收入院治疗。本项基于人群的研究旨在确定 TIA 患者住院期间及出院后 3 个月内的卒中发生率、出院后 3 个月内的死亡率和再入院率。

方法

在 36 个月的时间内（始于 2007 年 11 月），对来自石勒苏益格-荷尔斯泰因州（德国 16 个联邦州之一）15 家医院的 2200 例连续 TIA 患者（平均年龄 70.6±12.8 岁，49%为女性）进行前瞻性评估，评估内容包括住院期间和出院后 3 个月的随访。主要结局为住院期间和出院后 3 个月内的卒中、再入院和 3 个月时的死亡率。采用校正后的逻辑回归分析计算比值比（OR）。

结果

在 2200 例患者中（发病后中位入院时间为 6 小时），24 例（1.1%；95%置信区间 [CI]，0.7%-1.5%）患者在住院期间发生卒中（平均 6 天），1335 例患者中有 38 例（2.8%；95% CI，2.1%-3.8%）在出院后 3 个月内发生卒中。住院期间发生卒中与男性（OR，3.5）和脑影像学检查发现急性脑梗死（OR，2.6）独立相关，而 3 个月内发生卒中与年龄大于 65 岁（OR，3.0）独立相关。既往有卒中史（OR，1.7）的患者再入院率（11.1%；95% CI，9.3%-12.7%）增加，而出院时服用他汀类药物（OR，0.6）的患者再入院率降低。3 个月死亡率（1.4%；95% CI，0.9%-1.9%）与单侧无力（OR，2.6）和心房颤动（AF）（OR，2.6）独立相关。