摘要
目的研究重症监护病房(intensive care unit,ICU)围绝经期脑卒中患者神经功能恢复的影响因素。方法选取2022年1月至2025年1月于台州市第一人民医院ICU治疗的98例围绝经期ICU脑卒中患者作为研究对象。按照神经功能恢复情况分为良好组(神经功能恢复良好,n=22)与不良组(神经功能恢复不良,n=76)。比较两组患者的一般资料,包括年龄、体质量指数、入院时急性生理及慢性健康状况评估量表(acute physiology and chronic health evaluation,APACHEⅡ)评分、并发症、咽反射、咳嗽反射、脑卒中类型、格拉斯哥昏迷量表(Glasgow coma scale,GCS)评分和序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分。比较两组患者的生化指标,包括白细胞计数、淋巴细胞计数、血小板计数、血红蛋白水平、脑源性神经营养因子(brain-derived neurotrophic factor,BDNF)。比较两组患者的围绝经期相关指标,包括雌激素、激素治疗史、生殖衰老分期(STRAW+10)。进行多因素Logistic回归分析,并采用受试者操作特征曲线分析Logistic回归对ICU围绝经期脑卒中患者神经功能的影响因素。结果良好组处于绝经过渡早期患者的APACHEⅡ评分、GCS评分、淋巴细胞计数、BDNF、雌二醇、STRAW+10分期分别为(14.22±2.85)分、(10.45±2.14)分、(1.43±0.32)×10^(9)、(3.65±0.37)μg/L、(89.65±10.63)pmol/L、63.64%(14/22),不良组为(15.96±3.11)分、(9.23±2.02)分、(1.25±0.29)×109、(3.41±0.31)μg/L、(74.82±9.30)pmol/L、60.53%(46/76),差异有统计学意义(χ^(2)/t=2.353、2.462、2.505、3.059、6.376、4.026,均P<0.05)。APACHEⅡ评分(OR=5.223)、GCS评分(OR=0.228)、雌二醇(OR=0.270)、STRAW+10分期(OR=2.598)是ICU围绝经期脑卒中患者神经功能的影响因素(P<0.05)。APACHEⅡ评分、GCS评分、雌二醇、STRAW+10分期对ICU围绝经期脑卒中患者神经功能影响的曲线下面积分别为0.807、0.792、0.762、0.786。结论APACHEⅡ评分、GCS评分、雌二醇、STRAW+10分期是ICU围绝经期脑卒中患者神经功能恢复的影响因素。
Objective To investigate the influencing factors of neurological function recovery in perimenopausal stroke patients in the intensive care unit(ICU).Methods A total of 98 perimenopausal stroke patients treated in the ICU in Taizhou First People’s Hospital from January 2022 to January 2025 were enrolled as the research subjects.According to the status of neurological function recovery,they were divided into good recovery group(with good neurological function recovery,n=22)and poor recovery group(with poor neurological function recovery,n=76).The general data of the two groups were compared:age,body mass index,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score at admission,complications,pharyngeal reflex,cough reflex,type of stroke,Glasgow coma scale(GCS),and sequential organ failure assessment(SOFA)score.Compare the biochemical indicators of two groups:white blood cell count,lymphocyte count,platelet count,hemoglobin level,and brain-derived neurotrophic factor(BDNF).Compare the perimenopausal related indicators of two groups:estrogen,history of hormone therapy,and reproductive aging stage(STRAW+10).Multivariate Logistic regression analysis was conducted,and the receiver operator characteristic curve was used to analyze the effects of the factors in Logistic regression on the neurological function of perimenopausal ICU stroke patients.Results The APACHEⅡscore,GCS score,lymphocyte count,BDNF level,estradiol level,and the proportion of early menopausal transition stage in the STRAW+10 stage in good recovery group were(14.22±2.85)points,(10.45±2.14)points,(1.43±0.32)×109,(3.65±0.37)μg/L,(89.65±10.63)pmol/L,and 63.64%(14/22),while those in poor recovery group were(15.96±3.11)points,(9.23±2.02)points,(1.25±0.29)×109,(3.41±0.31)μg/L,(74.82±9.30)pmol/L,and 60.53%(46/76).The differences were significant(χ^(2)/t=2.353,2.462,2.505,3.059,6.376,4.026,all P<0.05).The APACHEⅡscore(OR=5.223),GCS score(OR=0.228),estradiol level(OR=0.270),and STRAW+10 stage(OR=2.598)were the influencing factors of neurological function in perimenopausal stroke patients in the ICU(P<0.05).The areas under the curves of the APACHEⅡscore,GCS score,estradiol level,and STRAW+10 stage for their influence on the neurological function of perimenopausal stroke patients in the ICU were 0.807,0.792,0.762,and 0.786.Conclusion The APACHEⅡscore,GCS score,estradiol level,and STRAW+10 stage are the influencing factors for the recovery of neurological function in perimenopausal stroke patients in the ICU.
作者
朱静园
张海英
ZHU Jingyuan;ZHANG Haiying(Taizhou First People’s Hospital,Taizhou 318020,Zhejiang,China)
出处
《中国现代医生》
2025年第36期36-40,共5页
China Modern Doctor
关键词
脑卒中
重症监护病房
神经功能恢复
围绝经期
影响因素
Stroke
Intensive care unit
Neurological function recovery
Perimenopause
Influencing factors
