Censori B, Camerlingo M, Casto L, Ferraro B, Gazzaniga G C, Cesana B, Mamoli A
Second Division of Neurology, Ospedali Riuniti, Bergamo, Italy.
Stroke. 1993 Apr;24(4):532-5. doi: 10.1161/01.str.24.4.532.
We sought to detect prognostic factors related to functional outcome during the first 6 hours after a first-ever stroke in the carotid artery territory.
All patients with these characteristics seen during a 3-year period were included. Outcome was evaluated according to a modified Rankin scale. The following variables were examined at univariate analysis: sex, age, severity of deficit at entry and at day 7, level of consciousness at entry, time after symptom onset, history of smoking, history of hypertension, diabetes, myocardial infarction, atrial fibrillation, rheumatic heart disease, dilated cardiomyopathy, all potential cardioembolic sources, presence of a consistent lesion on computed tomography at entry and at days 5-9, and the size of such lesion.
All entry criteria were met by 172 patients. Age > or = 70 years, a Canadian Neurological Scale score < 6.5 at entry and at day 7, atrial fibrillation, presence of a potential cardioembolic source, and a "large" lesion (involving more than half the cerebral lobe) on computed tomography at days 5-9 were associated with a significantly worse outcome both at 30 days and at 6 months. After multivariate analysis, a Canadian Scale score < 6.5 at entry (p < 0.0001) and atrial fibrillation (p = 0.005) were associated with a significant handicap or death at 30 days, whereas only a Canadian Scale score < 6.5 (p < 0.0001) was associated with a worse prognosis at 6 months. An association of age > or = 70 years with a worse outcome at 6 months was of borderline significance (p = 0.054).
Some prognostic indicators are available during the first few hours after onset of a carotid ischemic stroke and may be useful in the stratification of patients in clinical trials. Severity of deficit is the most important indicator, whereas the presence of atrial fibrillation worsens the prognostic outlook with respect to early handicap but not mortality.
我们试图检测首次发生在颈动脉供血区的卒中后最初6小时内与功能转归相关的预后因素。
纳入3年内符合这些特征的所有患者。根据改良Rankin量表评估转归。在单因素分析中检测以下变量：性别、年龄、入院时及第7天时的缺损严重程度、入院时的意识水平、症状发作后的时间、吸烟史、高血压史、糖尿病、心肌梗死、心房颤动、风湿性心脏病、扩张型心肌病、所有潜在的心源性栓塞源、入院时及第5 - 9天时计算机断层扫描上一致性病变的存在情况以及该病变的大小。
172例患者符合所有入选标准。年龄≥70岁、入院时及第7天时加拿大神经功能量表评分<6.5、心房颤动、存在潜在的心源性栓塞源以及第5 - 9天时计算机断层扫描上有“大”病变（累及超过半个脑叶）与30天时和6个月时明显更差的转归相关。多因素分析后，入院时加拿大神经功能量表评分<6.5（p<0.0001）和心房颤动（p = 0.005）与30天时显著的残障或死亡相关，而仅入院时加拿大神经功能量表评分<6.5（p<0.0001）与6个月时更差的预后相关。年龄≥70岁与6个月时更差的转归之间的关联具有临界显著性（p = 0.054）。
在颈动脉缺血性卒中发作后的最初数小时内可获得一些预后指标，这些指标可能有助于在临床试验中对患者进行分层。缺损严重程度是最重要的指标，而心房颤动的存在会使早期残障的预后前景恶化，但不会影响死亡率。
