| Stroke is a syndrome of neurologic impairment which is caused by acute brain blood dysaemia, including cerebral hemorrhage, cerebral infarction and subarachnoid hemorrhage. Stroke, which is one of the disease that threaten human's health and quality of life severely, has high incidence rate, mortality rate and mutilation rate over the world. The annual incidence rate of stroke is about 61/100 thousand to 388/100 thousand and the mortality rate is approximately 16.1/100 thousand to 113/100 thousand. In China, the annual incidence rate of stroke is about 120/100 thousand to 180/100 thousand and the mortality rate is approximately 60/100 thousand to 120/100 thousand. Recently studies found that with effectively curing, reasonably intervening the risk factors influencing prognosis in stroke patients can degrade case-fatality rate and mutilation rate efficiently.In order to analyze the risk factors significantly influencing prognosis in stroke patients, we studied 660 acute stroke inpatients, including 406 ischemic stroke patients and 254 hemorrhagic stroke patients. 27 factors that may be related to prognosis, including age, gender, initial NIHSS, glucose, serum albumin, uric acid and so on, were analyzed. Multivariate regression analysis was used to determine the main factors to the prognosis. At last, we found there were 4 risk factors significantly influencing prognosis of ischemic stroke and 4 risk factors significantly influencing prognosis of hemorrhagic stroke.Multivariate regression analysis showed that:1) Initial NIHSS, blood urea nitrogen, platelet count and serum albumin were confirmed as independent predictors of the prognosis of ischemic stroke. Among the total, initial NIHSS increased one score, then the possibility of prognosis getting better decreased nearly 70% (OR = 0.689, 95%CI =0.633~0.751); blood urea nitrogen level increased 1mmol/L, then the possibility of prognosis getting better decreased nearly 76.2% (OR=0.762, 95%CI=0.638~0.910); platelet count increased 1×106/L, then the possibility of prognosis getting better increased 1.008 time (OR=1.008, 95%CI=1.003~1.013); serum albumin level increased 1g/L, then the possibility of prognosis getting better increased nearly 1.083 time (OR=1.083, 95%CI=1.035~1.133).2) Brain tissue displacement, initial temperature, initial NIHSS and serum albumin were confirmed as independent predictors of the prognosis of hemorrhagic stroke. Among the total, patients of brain tissue displacementwhose possibility of prognosis getting better were 26.3% compared to those no brain tissue displacement's (OR=0.263, 95%CI=0.107~0.642); the fever patients whose possibility of prognosis getting better were 37.2% to those absence of fever's (OR=0.372, 95%CI=0.169~0.821); initial NIHSS increased one score, then the possibility of prognosis getting better decreased 67% (OR=0.670, 95%CI = 0.594~0.756); serum albumin increased 1g/L, then the possibility of prognosis getting better increased 1.138 time (OR=1.138, 95%CI=1.097~1.181).3) The study showed that initial NIHSS and the level of serum albumin were significant factors to both ischemic and hemorrhagic stroke.①Initial NIHSS can reflect the degree of patients'condition on admission directly. The higher NIHSS got, the more serious neurologic impairment did. Initial NIHSS increased one score, then the possibility of prognosis for ischemic stroke getting better decreased nearly 70%; and the possibility of prognosis for hemorrhagic stroke getting better decreased 67%.②Low serum albumin is a significant index of malnutrition. Malnutrition can decrease organism immunity, increase the chance of hospital infection, affect the recovery of patients'motor function. Serum albumin level increased 1g/L, then the possibility of prognosis for ischemic stroke getting better increased nearly 1.083 time; and the possibility of prognosis for hemorrhagic stroke getting better increased 1.138 time. In our study, general state of health (age, gender, initial blood pressure), history of past illness (stroke, hypertensive disease, coronary artery disease, diabetes), blood cell (WBC, NE%, MPV), blood biochemistry(GLU, UA), bloodion (Na+, K+), blood fat (TG, TC, HDL, VLDL, LDL, LPa), and electro- cardiogram were rejected by Logistic multivariate regression analysis, but we should not consider these factors have no influence to the prognosis of stroke yet. And some scholars discovered that factors such as serum glucose, blood uric acid, blood ion, et al, influenced the prognosis of stroke. The reason may be the time of viewing the prognosis was relative short and the methods of the study were different. Multicentre, large sample and prospective study may be better, and the results are more reliable.In conclusion, high initial NIHSS, high initial temperature, high blood urea nitrogen, low serum albumin level, low platelet count and brain tissue displacement were the main risk factors influencing prognosis in stroke patients. Therefore, with the effectively curing, we can improve the prognosis of stroke patients by reasonably intervening the primary factors influencing the prognosis of stroke patients. |
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