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目的探究上海市闵行区居民脑梗死复发的基本情况及影响脑梗死复发的危险因素,为采取有效干预措施预防脑梗死的复发提供依据。方法选取2010-2011年于上海市第五人民医院、闵行区中心医院和吴泾医院诊断为初发缺血性脑梗死的1 000例患者为研究对象,于2010年1月1日起由经上海市第五人民医院和闵行区疾病预防控制中心培训的调查员对闵行区心脑血管疾病监测点的报告病例进行随访核实,确认其为第1次发病,然后纳入研究,随访时间截至2015年12月31日。随访采用电话、家访或门诊复诊方式进行。用SPSS 20.0软件对数据进行统计学分析,计算脑梗死复发率,应用Cox比例风险模型对影响脑梗死复发的危险因素分别进行单因素和多因素分析。结果截至随访结束,共获得有效病例651例,其中复发233例,复发率为35.79%,84.55%的复发人群在初次发病后2年内复发。Cox多因素回归分析显示,发病年龄、高血压、其他心脏病和脑卒中、高血压或冠心病家族史是影响脑梗死复发的危险因素(RR值分别为1.022、2.008、1.532和1.535,P<0.01,P<0.05)。结论应针对脑梗死发病年龄较大,患高血压、其他心脏病,有脑卒中、高血压或冠心病家族史的患者重点采取预防脑梗死复发的干预措施。脑梗死初次发病后应加强对高血压、房颤等危险因素的预防和控制。
Objective To investigate the basic situation of recurrent cerebral infarction and the risk factors affecting the recurrence of cerebral infarction in Minhang District, Shanghai, and provide evidence for effective interventions to prevent the recurrence of cerebral infarction. Methods A total of 1 000 patients diagnosed as having ischemic cerebral infarction in the Fifth People ’s Hospital of Shanghai, Minhang Central Hospital and Wujing Hospital from 2010 to 2011 were selected as research objects. From January 1, 2010, City Fifth People’s Hospital and Minhang District Center for Disease Control and Prevention investigators on the monitoring of cardiovascular and cerebrovascular disease in Minhang District reported cases were followed up to verify that it is the first incidence and then included in the study, follow-up as of December 2015 On the 31st of the month. Follow-up by telephone, home visits or outpatient visits way. Data were analyzed by SPSS 20.0 software to calculate the recurrence rate of cerebral infarction. Cox proportional hazards model was used to analyze the risk factors affecting the recurrence of cerebral infarction by univariate and multivariate analysis respectively. Results As of the end of follow-up, a total of 651 effective cases were obtained, of which 233 cases relapsed, the recurrence rate was 35.79%. 84.55% of the recurrence patients relapsed within 2 years after the initial onset. Cox multivariate regression analysis showed that age of onset, hypertension, other heart disease and stroke, hypertension or family history of coronary heart disease were the risk factors influencing the recurrence of cerebral infarction (RR = 1.022,2.008,1.532 and 1.535, P < 0.01, P <0.05). Conclusions Interventions to prevent recurrence of cerebral infarction should be taken in patients with older onset of cerebral infarction, high blood pressure, other heart disease, stroke, hypertension or family history of coronary heart disease. After the initial onset of cerebral infarction should strengthen the prevention and control of hypertension, atrial fibrillation and other risk factors.