Kelly-Hayes M, Wolf P A, Kannel W B, Sytkowski P, D'Agostino R B, Gresham G E
Department of Neurology, Boston University School of Medicine, MA 02118.
Arch Phys Med Rehabil. 1988 Jun;69(6):415-8.
The distinction between factors that influence survival after stroke and those that increase the likelihood of institutionalization is an important health issue. Estimates of survival and frequency of institutionalization after stroke vary widely, depending on the patient population. A precise picture of variability of outcome from stroke may be obtained from a prospective epidemiologic study. This report uses the Framingham Study population sample of 5,184 men and women, aged 30 to 62 at entry in 1948, who were free of cardiovascular disease. All completed strokes that occurred between 1971 and 1981 were evaluated. Of the 213 patients with completed strokes, 154 survived more than 30 days. Multivariate logistic regression analysis indicated that acute survival was negatively influenced by stroke type, severity of neurologic impairment, and age. For those who survived at least 30 days, independent living was determined by social factors as much as by severity of disability. Being married protected men but not women from institutionalization. Older women, married or not, with moderate to severe residual impairment and minimal education, were at highest risk of institutionalization. In acute stroke, medical factors dominated rates of survival. However, in those who survived, family and social factors had an equal impact in determining final outcome from stroke.
影响中风后生存率的因素与增加入住机构可能性的因素之间的区别是一个重要的健康问题。中风后的生存率和入住机构的频率估计差异很大，这取决于患者群体。通过前瞻性流行病学研究可以获得中风结局变异性的精确情况。本报告使用了弗雷明汉研究的人群样本，该样本包括1948年纳入研究时年龄在30至62岁之间、无心血管疾病的5184名男性和女性。对1971年至1981年间发生的所有完全性中风进行了评估。在213例完全性中风患者中，154例存活超过30天。多变量逻辑回归分析表明，急性生存期受到中风类型、神经功能缺损严重程度和年龄的负面影响。对于那些至少存活30天的患者，独立生活由社会因素和残疾严重程度共同决定。已婚男性而非女性可免于入住机构。年龄较大的女性，无论已婚与否，有中度至重度残余功能缺损且受教育程度低，入住机构的风险最高。在急性中风中，医学因素主导生存率。然而，在存活的患者中，家庭和社会因素在决定中风最终结局方面具有同等影响。
