The Clinical And Etiological Analysis Of In-hospital Stroke

Background:The Stroke is a high incidence and high morbidity and high mortality. Strokeoccurred in patients during hospitalization, known as in-hospital stroke. Hospitalizedpatients with various underlying diseases and treatment, which often leads to sickerpatients, and poor prognosis, and easily lead to medical dispute. Therefore, theclinicians improve the understanding of the etiology and mechanisms of in-hospitalstroke, which great help for the prevention and timely processing in-hospital stroke.Objective:Review the clinical data of hospital patients with in-hospital stroke, analysis ofin-hospital stroke department distribution characteristics, gender, age differences, andclinical features. Investigate the related risk factors and pathogenesis, for early tojudge the disease and timely intervention to provide a theoretical basis, and to betterguide clinical treatment, thereby reducing its incidence, mortality and improve theirquality of life.Methods:The study collected the patients hospitalized in the First Affiliated Hospital ofNanchang University in January2001to November2011. Admission in patientshospitalized due to other non-stroke reasons, the occurrence of stroke duringhospitalization, clinical data of72cases. Registration of the clinical data of patientswith stroke, record the occurrence of stroke time, related inspection, treatment givenand record patients with stroke etiology and risk factors, understanding the patient’shospital stay and its prognosis. Hospitalized patients in the Department of Cardiologyin January2005to November2011a total of2763cases, from which extracted thesample of130cases by random to compose Cardiovascular Division in the controlgroup. Department of Cardiology clinical data of26patients selected from the72cases of in-hospital stroke patients compared with the control group of theCardiovascular Division, and analyze the characteristics of its etiology and risk factors.Results:1. The general clinical features: In the incidence of hospital stroke departments,53cases of medical system diseases, accounting for73.61%, including department ofCardiology (26cases), accounting for49.06%of the medical system diseases; Maleto female ratio was1.4:1, men constitute higher than the female; Hemorrhagic stroketended to be younger, ischemic stroke tends to aging, but no significant differencebetween the age of ischemic stroke and hemorrhagic stroke.2. The characteristics of in-hospital stroke etiology and incidence of stroke time:In-hospital stroke patients with stroke associated with atrial fibrillation in17cases(23.61%), hypertension in38cases (52.78%), type2diabetes in12cases (16.67%),myocardial infarction in2cases (2.78%), hyperlipidemia in15cases of (20.83%),infection in26cases (36.11%), carotid artery plaque in9cases (12.50%) and previoushistory of stroke in7cases (9.72%). The existence of one kinds, two kinds, three kinds,four kinds and more underlying diseases in patients before stroke were6cases,18cases,27cases and21cases respectively. In-hospital stroke patients onset <48hours26cases,48h to1week32cases, more than one week14cases. Six cases werediagnosed within6hours of onset,19cases were diagnosed within12h,39caseswere diagnosed within24h, the longest diagnosis time72h, the average diagnosistime22h.3. The stroke may be the incentive for: Ischemic stroke may be the incentive for23cases of lowering blood pressure too fast,13cases of atrial fibrillation, nine casesof blood viscosity, two cases of acute myocardial infarction,8cases of low bloodvolume, and one case of coagulation abnormalities,9cases of perioperative and onecause of other reasons. Hemorrhagic stroke may be the incentive for excited or hardbowel movements three cases, one each of Surgical stress, Coagulation abnormalitiesand hemodialysis.4. Risk factors: Analyzed the various risk factors for cardiovascular group andcontrol group, including age, smoking history, drinking history, hypertension, atrialfibrillation, infection and history of previous stroke were significant association withhospital stroke(P <0.05). Unconditioned with Logistic regression analysis showed that hypertension, infection, atrial fibrillation and previous stroke history weresignificantly associated with in-hospital stroke.5. Clinical symptoms: In-hospital stroke patients with onset of sleep or quiet, atotal of67cases, other5cases at the onset of activities or emotional. The mostcommon first symptom is limb weakness and numbness,35cases (48.61%). Otherinitial symptoms include: Disturbance of consciousness of18cases (25.00%),headache, dizziness in6cases (8.33%), psychiatric symptoms in5cases (6.94%),speech disorder in3cases (4.17%), each of2cases (2.78%) in blurred vision andconvulsion, difficulty swallowing in one case (1.39%).6. The duration of hospitalization and prognosis: In72cases of in-hospital strokepatients,58cases improved and discharged after treatment, with nine casesautomatically discharged, and five cases of death and discharged, the effective rate93.06%. Among of them,14cases fully recovered,17cases of mild limb dysfunction,25patients with moderate limb dysfunction,11cases of severe paralysis.Conclusions:1. In-hospital stroke department distributed most of the medical system diseases,especially the department of Cardiology. The majority of in-hospital stroke isischemic stroke, and men accounted for the most;2. The major cause of in-hospital stroke is high blood pressure, other casesfollowed by infection, atrial fibrillation and so on; The incentive of the in-hospitalstroke occurs lowering blood pressure too fast and other common causes includeatrial fibrillation, perioperative, blood viscosity and so on;3. The in-hospital stroke possible risk factors including age, smoking history,drinking history, hypertension, atrial fibrillation, infection and history of previousstroke;4. Hypertension, infection, atrial fibrillation, previous stroke history weresignificant association with in-hospital stroke. Timely, early intervention and controlof these risk factors have a major significance for reducing its incidence;5. The in-hospital stroke onset of clinical symptoms varied, but the numbness,weakness, and disturbance of consciousness is more common, when hospitalizedpatients with these symptoms should be a timely manner; 6. Most of the in-hospital stroke patients with good prognosis, for the existenceof stroke in patients with underlying diseases, should control the risk factors for earlyintervention, to prevent and eliminate the potential risk of stroke to reduce theincidence of in-hospital stroke, and improve patient outcomes.