Lucente Giuseppe, Corral Javier, Rodríguez-Esparragoza Luis, Castañer Sara, Ortiz Hector, Piqueras Anna, Broto Joaquim, Hernández-Pérez María, Domenech Sira, Martinez-Piñeiro Alicia, Serra Jordi, Almendrote Miriam, Parés David, Millán Mònica
Neurology Service, Neuroscience Department, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain.
General Surgery Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Front Neurol. 2021 Nov 1;12:755432. doi: 10.3389/fneur.2021.755432. eCollection 2021.
Previously published retrospective series show a high prevalence of fecal incontinence (FI) in stroke patients. We aimed to analyze in a prospective series the current incidence of FI in acute stroke in functionally independent patients and its evolution over time and the patient characteristics associated with the appearance of FI in acute stroke. We included consecutive patients with acute stroke admitted in our stroke unit who fulfilled the following inclusion criteria: a first episode of stroke, aged >18 years, with no previous functional dependency [modified Rankin Scale (mRS) ≤ 2] and without previous known FI. FI was assessed by a multidisciplinary trained team using dedicated questionnaires at 72 ± 24 h (acute phase) and at 90 ± 15 days (chronic phase). Demographic, medical history, clinical and stroke features, mortality, and mRS at 7 days were collected. Three hundred fifty-nine (48.3%) of 749 patients (mean age 65.9 ± 10, 64% male, 84.1% ischemic) fulfilled the inclusion criteria and were prospectively included during a 20-month period. FI was identified in 23 patients (6.4%) at 72 ± 24 h and in 7 (1.9%) at 90 days ± 15 days after stroke onset. FI was more frequent in hemorrhagic strokes (18 vs. 5%, p 0.007) and in more severe strokes [median National Institute of Health Stroke Scale (NIHSS) 18 (14-22) vs. 5 (3-13), < 0.0001]. No differences were found regarding age, sex, vascular risk factors, or other comorbidities, or affected hemisphere. Patients with NIHSS ≥12 (AUC 0.81, 95% CI 0.71 to 0.89) had a 17-fold increase for the risk of FI (OR 16.9, IC 95% 4.7-60.1) adjusted for covariates. At present, the incidence of FI in acute stroke patients without previous functional dependency is lower than expected, with an association of a more severe and hemorrhagic stroke. Due to its impact on the quality of life, it is necessary to deepen the knowledge of the underlying mechanisms to address therapeutic strategies.
先前发表的回顾性系列研究表明，中风患者中大便失禁（FI）的患病率很高。我们旨在通过前瞻性系列研究分析功能独立的急性中风患者中FI的当前发病率、其随时间的演变以及与急性中风中FI出现相关的患者特征。我们纳入了在我们的中风单元收治的符合以下纳入标准的连续急性中风患者：首次中风发作、年龄>18岁、既往无功能依赖[改良Rankin量表（mRS）≤2]且既往无已知的FI。由多学科训练有素的团队在72±24小时（急性期）和90±15天（慢性期）使用专用问卷对FI进行评估。收集人口统计学、病史、临床和中风特征、死亡率以及7天时的mRS。749例患者中的359例（48.3%）（平均年龄65.9±10岁，64%为男性，84.1%为缺血性中风）符合纳入标准，并在20个月期间前瞻性纳入研究。中风发作后72±24小时有23例患者（6.4%）被确定为FI，90天±15天时为7例（1.9%）。FI在出血性中风中更常见（18%对5%，p=0.007），在更严重的中风中也更常见[美国国立卫生研究院中风量表（NIHSS）中位数18（14-22）对5（3-13），p<0.0001]。在年龄、性别、血管危险因素或其他合并症、或受影响的半球方面未发现差异。NIHSS≥12的患者（AUC 0.81，95%CI 0.71至0.89）在调整协变量后发生FI的风险增加了17倍（OR 16.9，95%CI 4.7-60.1）。目前，既往无功能依赖的急性中风患者中FI的发病率低于预期，且与更严重的出血性中风有关。由于其对生活质量的影响，有必要深入了解潜在机制以制定治疗策略。
