| Objective:To discusses the diagnosis and treatment of patients with cerebral infarction in three hospitals in zhangjiagang city;to analyze the factors affecting the mortality and survival of patients with cerebral infarction within 3 years,and related factors of short-term and long-term adverse outcomes.It provides basis for the diagnosis and treatment of regional acute cerebral infarction,reducing the related mortality of stroke and reducing the poor prognosis.Method:Gathering in December 2013-June 2014,a total of 442 cases of clinic in Zhangjiagang city of three tertiary hospitals within 1 week of hospitalized patients with acute cerebral infarction,establish a database for entry(gender,age,disease-in hospital time,hospitalization days,NIHSS score,TOAST classification,OCSP classification,medical history,hobby of alcohol or tobacco,clinical laboratory results),and in June-July 2017 to telephone pays a return visit,record the current medications and grade it with the modified Rankin scale,excluding 80 eliminate cases of patients with the incomplete baseline information and lost to follow-up,the remaining 362 patients were retrospectively analyzed,the survival curve was analyzed according to the time of death registered in the center for disease control and prevention of zhangjiagang.Result:1.Comparison of patient's baseline data in 3 hospitals: this study investigated retrospectively 362 cases of acute cerebral infarction patients,according to different hospital statistics,56 cases of A hospital,228 cases of B hospital,78 cases of C hospital.The number of cerebral infarction in B hospital is far higher than that of the other two hospitals,with a large number of patients,accounting for 63%.The disease-in hospital time of hospital B is shortest,the NIHSS score on admission,m RS score at discharge,NIHSS score at discharge are the highest(P<0.001).In OCSP classification,the complete anterior circulation of cerebral infarction in hospital B accounted for 10.5%(P=0.026).In the TOSAT classification,A hospital was mainly composed of aortic atherosclerosis(71.4%,P=0.001),with a large number of patients with hypertension(87.5%,P=0.016),and the highest hypertensive compliance(76.7%,P<0.001).The oneset age was the youngest in C hospital(66(38,89),P=0.008),and the length of hospital stay was shorter(11(1,37),P<0.001).From the laboratory results,the d-dimer of A hospital was higher(0.545(0.02,6.31),P<0.001),higher urea nitrogen(6.09(2.97,12.1),P=0.002),high-density lipoprotein(1.365(0.66,3.13),P<0.001).2.Analysis of death and survival groups within 3 years: in the three years,there were 70 cases of death group and 292 cases of survival group,and the total mortality was 19.3% in 3 years.The patients of death group in three years were older than the survival group(P<0.001),the NIHSS score on admission,m RS score at discharge,NIHSS score at discharge were higher in death group(P<0.001),the patients with atrial fibrillation were more in death group(P<0.001),and the first stroke ratio in survival group is higher(P=0.008),in addition,there were more smokers in survival group(P<0.001),and alcohol was also found in survival group(P= 0.007).3.Compared patients with the short-term and long-term adverse outcomes: The disease-in hospital time of patients with short-term poor prognosis is shorter(P=0.016),hospitalization days is more shorter than long-term patients with poor prognosis(10.52±7.4,P=0.001),and the NIHSS score on admission,m RS score at discharge,NIHSS score at discharge were higher in the long-term poor prognosis group(P<0.001).In the short-term group,the OCSP classification was mainly based on complete anterior circulation infarction(P=0.001).The medication compliance in the short-term group was worse than that in the long-term group(P<0.001),especially in platelet aggregation and statins(P<0.05),the short term adverse prognosis in patients with vascular death was higher than long-term rates of patients with poor prognosis(P=0.037).Conclusion:1.The etiology of acute cerebral infarction in Zhangjiagang area was mainly caused by atherosclerosis,and the infarction area was dominated by anterior circulation infarction;age was an independent risk factor for poor prognosis in patients with acute cerebral infarction;age and the severity of neurological function in admission were the independent risk factors for all death within 3 years.2.The patients with poor prognosis in short term mainly based on the complete anterior circulation infarction,the medication compliance in the short-term group with poor prognosis was worse than that in the long-term group. |
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