急性缺血性脑卒中病人早期神经功能 恶化的危险因素分析及护理对策

目的探讨急性缺血性脑卒中（acute ischemic stroke，AIS）早期神经功能恶化（early neurological deterioration，END）的危险因素及护理对策。方法回顾深圳市某三甲医院神经内科2014-2017年AIS病人，发病后7 d内NIHSS总分增加≥ 2分提示END，分成END组68例和非EMD组334例，单因素分析对比2组临床资料，并进行多因素logistic回归分析，判定END发生的独立危险因素。结果2组在体温、房颤病史、颈动脉中重度狭窄、基线NIHSS评分、高血糖、同型半胱氨酸、C反应蛋白、白细胞等方面差异有统计学意义（P < 0.01）；logistic多因素回归分析显示，颈动脉狭窄≥ 50%（OR=2.483，95%CI:1.020~6.044）、高基线NIHSS评分（OR=1.219，95%CI:1.135~1.310）、高血糖（OR=1.101，95%CI:1.009~1.202）、高C反应蛋白（OR=1.029，95%CI:1.007~1.052）、高白细胞水平（OR=1.172，95%CI:1.042~1.319）是发生END的独立危险因素。结论颈动脉狭窄≥ 50%、基线NIHSS评分越高、血糖越高、C反应蛋白越高、白细胞水平越高的病人，发生END的风险越大，为临床护理人员评估AIS病人病情、指导个体化治疗及护理措施提供借鉴。

Risk factors analysis and nursing measures of early neurological deterioration in patients with acute ischemic stroke

ObjectiveTo explore the related risk factors and nursing measures of early neurological deterioration (END) in patients with acute ischemic stroke (AIS).MethodsFour hundred and two patients with AIS from 2014 to 2017 were divided into the END group (68 cases with NIHSS score increasing by 2 or more within 7 days after onset) and non-END group (334 cases).The clinical data between two groups were compared using the univariate analysis, and the independent risk factor of END was analyzed using the logistic regression analysis.ResultsThe differences of the body temperature, history of atrial fibrillation, carotid artery stenosis, baseline NIHSS score, hyperglycemia, homocysteine, C reactive protein and white blood cell between two groups were statistically significant (P < 0.01). The results of multivariate logistic regression analysis showed that the carotid artery stenosis ≥ 50% (OR=2.483, 95%CI:1.020 to 6.044), high baseline NIHSS score (OR=1.219, 95%CI:1.135 to 1.310), high blood glucose (OR=1.101, 95%CI:1.009 to 1.202), high C reactive protein (OR=1.029, 95%CI:1.007 to 1.052) and high white blood cell level (OR=1.172, 95%CI:1.042 to 1.319) were the independent risk factors of END.ConclusionsThe more stenosis the carotid artery, higher the baseline NIHSS score, and higher the levels of blood glucose, C reactive protein and white blood cell, the greater the risk of END.The results can provide reference for clinical nurses to assess the condition of patients with AIS, and set individualized treatment and nursing measures.