老年人中风——更高的急性和3个月死亡率——一种解释。

Strokes in the elderly - higher acute and 3-month mortality - an explanation.

作者信息

Sharma J C, Fletcher S, Vassallo M

机构信息

King's Mill Centre for Healthcare Services NHS Trust, Sutton-in-Ashfield, UK.

出版信息

Cerebrovasc Dis. 1999 Jan-Feb;9(1):2-9. doi: 10.1159/000015889.

DOI:10.1159/000015889

PMID:9873157

Abstract

AIM

Stroke is common in older people. The objective of the study was to determine if older stroke patients have a higher mortality and disability compared with younger patients for comparable stroke severity and pathology and whether there is an explanation for the difference.

METHODS

A prospective study was undertaken in 296 consecutive patients admitted with acute stroke. Patients were studied for neurological features, pre-stroke functional disability, severity of stroke defined by stroke syndromes and pathology of stroke on CT scans (202 patients). Post-stroke disability was defined according to the functional status within 72 h of admission. A record was made of the intercurrent illness while the patients were in acute wards and of the risk factors. Patients were dichotomized into two age groups: younger group - up to 75 years (163 patients) and older group - over 75 years (133 patients). Outcome was measured according to (1) discharge status from acute wards, i.e., dead or alive, and (2) mortality at 3 months.

RESULTS

Although there was no significant difference in severe clinical stroke syndromes (p = 0.72), CT scan features (p = 0.68) and pyrexia (0.38) between the two age groups, the older patients had significantly more disabling strokes as defined on Barthel Index (p = 0.015) and a higher mortality in the acute phase (p < 0.01) and at 3 months (p = 0.001). The older stroke patients had more severe pre-stroke disability (p < 0.001) and more severe neurological impairment for similar stroke severity and pathology. Early mortality was more influenced by pre-stroke global health than age whereas 3-month mortality was influenced by age to the exclusion of all other known prognostic factors.

CONCLUSION

The older stroke patients have more disabling stroke and an increased mortality for a similar spectrum of stroke severity and pathology. The explanation for higher mortality of the older patients is the poor pre-stroke health and higher immediate post-stroke disability.

摘要

目的

中风在老年人中很常见。本研究的目的是确定与年轻患者相比，年龄较大的中风患者在中风严重程度和病理情况相当的情况下是否有更高的死亡率和残疾率，以及是否能对这种差异作出解释。

方法

对296例连续收治的急性中风患者进行了一项前瞻性研究。对患者的神经学特征、中风前功能残疾情况、根据中风综合征定义的中风严重程度以及CT扫描（202例患者）显示的中风病理情况进行了研究。中风后残疾情况根据入院72小时内的功能状态来定义。记录了患者在急性病房期间的并发疾病及危险因素。患者被分为两个年龄组：较年轻组——75岁及以下（163例患者）和较年长组——75岁以上（133例患者）。根据以下两点来衡量结果：（1）从急性病房出院的状态，即死亡或存活，以及（2）3个月时死亡率。

结果

尽管两个年龄组在严重临床中风综合征（p = 0.72）、CT扫描特征（p = 0.68）和发热情况（0.38）方面无显著差异，但根据巴氏指数定义，较年长患者有更多致残性中风（p = 0.015），且急性期（p < 0.01）和3个月时（p = 0.001）死亡率更高。对于中风严重程度和病理情况相似的情况，年龄较大的中风患者中风前残疾更严重（p < 0.001），神经功能损害更严重。早期死亡率受中风前整体健康状况的影响大于年龄，而3个月死亡率则受年龄影响，其他所有已知的预后因素均被排除在外。