确定缺血性卒中亚型:一种改进的算法及其在综合卒中单元中的应用

Y. Flomin
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引用次数: 0

摘要

目的:实现一种确定缺血性脑卒中(ICS)病因亚型的统一算法,并评估其在卒中综合病房(CSU)住院患者中的应用结果。材料和方法。该研究纳入了689例ICS患者(43.4%为女性,56.6%为男性;中位年龄为68.1岁(59.7-75.5),于2010年至2018年入住结构和流程符合CSU原则的医院单位。分析受试者的年龄、性别、美国国立卫生研究院卒中量表(NIHSS)和修正Rankin量表得分。所有患者都接受了初步检查,包括神经成像、血管成像、心脏病专家检查和一组实验室检查,以及由医生自行决定的高级评估。所有ICS被划分为四种病因亚型之一:心栓性、动脉粥样硬化性、腔隙性或其他。结果。根据提出的算法,294例(42.7%)被划分为心栓塞亚型,282例(40.9%)被划分为动脉粥样硬化亚型,52例(7.5%)被划分为腔隙性亚型,61例(8.9%)被划分为病因不明的缺血性脑卒中。与流行病学研究结果相比,主要病因学ICS亚型显示频率的差异是由于我们的样本中ICS的严重程度更高:基线NIHSS总分中位数为10(6-17),修正Rankin量表评分中位数为4(3-5),另一方面,使用现代诊断技术进行深入评估和更长时间的住院时间允许完成测试。在病因不明ICS占比较低的CSU患者中,通过全面的评估和基于病因分类的统一算法,可以成功确定ICS亚型,这是有效进行二级预防的关键。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Determining ischemic stroke subtype: an improved algorithm and its use in a comprehensive stroke unit
Objective ‒ to implement a inified algorithm for determining an ischemic cerebral stroke (ICS) etiological subtype and evaluate the results of its use in patients who were admitted to a comprehensive stroke unit (CSU).Materials and methods. The study enrolled 689 patients with ICS (43.4 % women, 56.6 % men; median age 68.1 years (59.7–75.5)) who in 2010 to 2018 were admitted to a hospital unit where the structure and processes correspond to the principles of CSU. The participants’ age, gender, National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale scores were analyzed. All patients underwent an initial workup that included neuroimaging, vascular imaging, a cardiologist’s exam and a set of laboratory tests, and an advanced evaluation, at his physician discretion. All ICS was assigned to one of the four etiological subtypes: cardioembolic, atherosclerotic, lacunar or other. Results. According to the proposed algorithm, 294 (42.7 %) cases were assigned to cardioembolic subtype, 282 (40.9 %) to atherosclerotic subtype, 52 (7.5 %) to lacunar subtype and 61 (8.9 %) to ischemic cerebral stroke unknown etiology. Differences in the shown frequency of the main etiological ICS subtypes compared to the results of epidemiological studies are due to the greater severity of ICS in our sample: baseline median NIHSS total score was 10 (6–17), and median modified Rankin scale score was 4 (3–5), and, on the other hand, to in-depth assessment using modern diagnostic technologies and a longer length of stay that allowed for the tests to be completed.Conclusions. Thorough evaluation and the use of a unified algorithm based on causal etiological classifications allow to successfully determine an ICS subtype in the CSU patients with low proportion of ICS of unknown etiology, which is the key to effective secondary prevention.
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