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急性重症卒中患者预后良好的相关因素:一项基于全国真实世界数据库的研究

Factors associated with favorable outcomes in acute severe stroke patients: A real-world, national database study.

作者信息

Kasemsap Narongrit, Vorasoot Nisa, Kongbunkiat Kannikar, Tiamkao Somsak, Boonsawat Watchara, Sawanyawisuth Kittisak

机构信息

Department of Medicine and North-Eastern Stroke Research Group, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.

出版信息

Biomed Rep. 2022 Jul 22;17(3):74. doi: 10.3892/br.2022.1557. eCollection 2022 Sep.

Abstract

Thrombolytic therapy is useful in severe stroke, but it increases the risk of intracerebral hemorrhage. In addition, it may have limited use in resource-limited due to a lack of trained neurologists and equipment to perform CT scans. There are limited data available from studies of national databases on stroke outcomes and predictors of severe stroke. This study, therefore, aimed to evaluate acute severe ischemic stroke outcomes in a real-world setting. Additionally, predictors of favorable stroke outcomes were explored using a retrospective cohort. Data were extracted from the National Health Security Office (NHSO) in Thailand. The inclusion criteria were: Aged ≥18 years or older, diagnosis of acute severe ischemic stroke (defined by an admission National Institutes of Health Stroke Scale score of 15-24), and available data on stroke outcomes. Outcomes were evaluated at discharge using a modified Rankin score at discharge. Factors associated with good outcomes were determined using multivariate logistic regression analysis. During the study period, 268 severe stroke patients met the inclusion criteria. Of those, 38 (14.18%) had good outcomes at discharge. A total of 223 patients received intravenous recombinant tissue plasminogen activator (83.21%). Of those, 38 (17.04%) had favorable outcomes. A predictive model for good outcomes revealed two independent factors: Male sex and atrial fibrillation with adjusted odds ratios (95% confidence interval) of 2.30 (1.10-4.82) and 0.38 (0.16-0.91), respectively. Predictors for good stroke outcomes in severe stroke patients included rtPA treatment, atrial fibrillation, and male sex.

摘要

溶栓治疗对重症中风有用,但会增加脑出血风险。此外,由于缺乏训练有素的神经科医生和进行CT扫描的设备,在资源有限的情况下其应用可能受限。关于中风结局和重症中风预测因素的全国性数据库研究可得的数据有限。因此,本研究旨在评估现实环境中急性重症缺血性中风的结局。此外,采用回顾性队列研究探索了中风良好结局的预测因素。数据取自泰国国家卫生安全办公室(NHSO)。纳入标准为:年龄≥18岁,诊断为急性重症缺血性中风(定义为入院时美国国立卫生研究院卒中量表评分为15 - 24分),且有中风结局的可用数据。出院时使用改良Rankin量表评估结局。使用多因素逻辑回归分析确定与良好结局相关的因素。在研究期间,268例重症中风患者符合纳入标准。其中,38例(14.18%)出院时结局良好。共有223例患者接受了静脉注射重组组织型纤溶酶原激活剂(83.21%)。其中,38例(占17.04%)结局良好。良好结局的预测模型显示两个独立因素:男性和心房颤动,调整后的优势比(95%置信区间)分别为2.30(1.10 - 4.82)和0.38(0.16 - 0.91)。重症中风患者中风良好结局的预测因素包括rtPA治疗、心房颤动和男性。

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