Analysis And Coping Methods Of Poor Functional Prognosis In Elderly Patients With Mild Ischemic Stroke

Objective:To explore the clinical characteristics of elderly patients with mild ischemic stroke,analyze the factors affecting the prognosis of poor function in elderly patients with mild ischemic stroke,and put forward some suggestions for the management of elderly patients with mild ischemic stroke.Method:This study collected mild ischemic stroke patients aged 80 and over who were hospitalized within 7 days of onset from January 2019 to September 2019 in Tianjin Huanhu Hospital.The functional prognosis of all patients were assessed by telephone or out-patient follow-up for 3 months.The subjects were divided into two groups: good functional prognosis group(m RS 0-2)and poor functional prognosis group(m RS 3-6).The baseline data,stroke severity at admission and discharge,early neurological deterioration rate,TOAST classification,treatment during hospitalization,laboratory tests,location of infarction,degree of intracranial and extracranial vascular stenosis,complications and adverse events at 3 months were compared between the two groups.Multivariate Logistic regression analysis was used to determine the independent risk factors for poor functional prognosis in patients aged 80 and over with mild ischemic stroke.Results:This study included 270 patients,including 186 patients with good functional prognosis and 84 patients with poor functional prognosis.Compared with the group with good functional prognosis,the group with poor functional prognosis had a higher prevalence of coronary heart disease(64.2% VS40.8%,P=0.002),chronic heart failure(9.5% VS 3.2%,P=0.013),renal insufficiency(14.2% VS 7.5%,P=0.031),the proportion of intracranial and intracranial vascular occlusion(28.6% VS 9.7%,PVS 40.8%,P=0.002)was higher.The incidence of pneumonia(19.2% VS 8.6%,P=0.002),urinary tract infections(9.6% VS2.2%,P=0.002)was higher,with higher admission NHISS score(2.89±1.60VS2.19±1.60,P=0.037)and higher discharge NHISS score(3.42±2.72 VS 1.74±1.63,P=0.001),higher rates of early neurological deterioration(16.7%VS 2.1%,P=0.002).The 3-month Stroke recurrence rate(19.8% VS 3.2%,P<0.001),and the risk of intracranial hemorrhage(4.8% VS 1.0%,P=0.028)was higher.Multivariate Logistic regression analysis showed: intracranial vascular occlusion(OR 2.832,95%CI1.234-6.497,P=0.014),pneumonia(OR 3.054,95%CI 1.256-7.423),urinary tract infection(OR 5.079,95%CI 1.259-19.489),early neurological deterioration(OR4.874,95%CI 1.263-12.957,P=0.025),recurrent stroke(OR 6.898,95%CI2.262-21.036,P=0.001)were independent risk factors for 3 months of poor functional outcomes in patients aged 80 and over with mild ischemic stroke.Conclusion:Recurrence of stroke,deterioration of early neurological function,pneumonia,urinary tract infection,and intracranial vascular occlusion are closely related to the prognosis of poor function in elderly patients with mild ischemic stroke.We should not only regulate the routine antiplatelet therapy of elderly patients with mild ischemic stroke,pay attention to the general treatment of patients with basic diseases,but also strengthen the prevention and treatment of stroke-related infections.Thrombolysis may be beneficial for patients with functional prognosis,but further large sample randomized controlled trial studies are needed.