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題名 | Potential Risk and Protective Factors for In-Hospital Mortality in Hyperacute Ischemic Stroke Patients=超急性缺血性腦中風病患住院中死亡之潛在危險因子及保護因子 |
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作者 | 李建勳; 許錦田; 陳俊鴻; 黃柏穎; 林瑞泰; Li, Chien-hsun; Khor, Gim-thean; Chen, Chun-hung; Huang, Poyin; Lin, Ruey-tay; |
期刊 | The Kaohsiung Journal of Medical Sciences |
出版日期 | 20080400 |
卷期 | 24:4 2008.04[民97.04] |
頁次 | 頁190-196 |
分類號 | 415.922 |
語文 | eng |
關鍵詞 | 超急性缺血性腦中風; 死亡率; 保護因子; 危險因子; 存活者; Hyperacute ischemic stroke; Morality; Protective factor; Risk factor; Survival; |
中文摘要 | 在血栓溶解療法應用於超急性缺血性腦中風的時代開啟之後,大部分的研究都集中在探討血栓溶解療法之後的死亡率及病情轉變,很少同時討論到未經血栓溶解療法病人的病況。我們的研究目的就是要探討所有超急性缺血性腦中風病人住院中死亡的影響因子。於 2005 年這一年內,我們收錄了在中風症狀發作後四小時內的超急性缺血性腦中風病患,並分析他們的潛在預後因子。我們共收錄了 101 位病人,43 位女性及 58 位男性,平均年齡為 68 歲。整體住院中死亡率為 17.8% (18/101)。根據 t test 統計分析,年齡 (p = 0.034)、急診到會診神經科醫師 (p < 0.0001) 和急診到病房住院的時間間距 (p = 0.001)、GCS (p = 0.001)、NIHSS (p < 0.0001) 及主要中風危險因子總數 (p < 0.0001),在死亡及存活組間存在顯著的差異。此外,這兩組於初始期意識障礙 (p = 0.001)、中風發生地 (p = 0.04) 及轉院運送 (p = 0.008) 有著顯著的不同。總結來說,年長者、延遲照會神經醫師及住院、中風嚴重度及多種中風危險因子與病患死亡有顯著的相關。相對的,未以意識模糊為初始表現者、居住在城市及直接運送病患到腦中風醫療中心,可視為存活的保護因子。我們強調 "腦發作" 的觀念應該於急診醫師間再廣為推廣。此外,腦中風醫療中心與緊急醫療系統應該建構成更緊密的聯絡網,促進超急性腦中風及時處置的成效及照護品質。 |
英文摘要 | In the era of thrombolytic therapy for hyperacute ischemic stroke, most investigators have focused their attention on the factors influencing mortality and functional outcomes in patients treated with thrombolysis, but very few have focused on these factors among patients not receiving thrombolysis. The aim of this study was to investigate the prognostic factors for mortality in all hyperacute stroke patients with or without thrombolysis. In 2005, we enrolled 101 ischemic stroke patients (43 females, 58 males; mean age, 68 years) who were transported to the emergency department (ED) within 4 hours of symptom onset. The overall in-hospital mortality rate was 17.8% (18/101). According to t test analysis, age (p = 0.034), time interval from neurologist consultation (p < 0.0001) and ED to ward admission (p = 0.001), Glasgow coma scale (GCS) (p = 0.001), National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001) and the sum of major risk factors of cerebrovascular disease (CVD) (p < 0.0001) were significantly different between mortality and survivor groups. Further Chi-squared test analysis revealed significant differences in the presenting consciousness disturbance (p = 0.001), place of attack (p = 0.04), and referral transportation (p = 0.008) between these groups. In conclusion, old age, delay between neurologist consultation and ward admission, severity of stroke, and multiple risk factors of CVD are significant risk factors for in-hospital mortality. Conversely, being free of initial consciousness disturbance, living in an urban area, and having direct transportation to a stroke center are protective factors in survivors. The concept of "brain attack" should be re-emphasized among ED physicians. The interconnection between stroke centers and emergency medical systems (EMS) should be more tightly built to promote timely management for hyperacute stroke care. |
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