■院内中风是一种严重的事件,与不良结局和高死亡率相关。然而,在危重患者中,识别卒中征象可能更为困难.
本研究调查了在医疗重症监护病房(MICU)接受脑计算机断层扫描(CT)的急性意识改变患者中院内卒中的患病率和独立预测因素。
■这项回顾性研究在2007-2017年期间招募了符合条件的患者。研究的改变是放射学证实的急性缺血性中风(AIS)和脑出血(ICH)。
■在4360名患者中,113例接受脑部CT检查。其中,31%有AIS,15%患有ICH。他们的舒张压和动脉pH值高于非中风患者。ICH患者的平均收缩压较高(标准偏差(SD)(152(48)v.129(25)mmHg;p=0.01),较低的平均(SD)格拉斯哥昏迷量表评分(4(3)v7(4);p=0.004),与AIS患者相比,瞳孔异常更多(75%对9%;p<0.001)。AIS患者年龄较大(65(18)v.57(18)岁;p=0.03),有更多的高血压(60%对39%;p=0.04),更常见的是巴宾斯基符号(26%对9%;p=0.04)。多变量分析发现,瞳孔异常独立预测ICH(校正比值比(aOR)26.9;95%CI3.7-196.3;p=0.001)。Babinski体征(aOR5.1;95%CI1.1-23.5;p=0.04)和碱性血症(动脉pH>7.4;aOR3.6;95%CI1.0-12.3;p=0.05)独立预测了AIS。
■该队列中有46%患有ICH或AIS。这两种情况都有很高的死亡率。瞳孔异常的存在预示着ICH,而Babinski征和碱性血症可预测AIS。
■本研究报告几乎一半(46%)意识改变的危重患者患有急性卒中。其中,三分之二患有急性缺血性中风(AIS),三分之一有颅内出血(ICH).多变量分析显示,瞳孔异常是ICH的预测因子,而Babinski体征被确定为AIS的预测因子。
UNASSIGNED: In-hospital stroke is a serious event, associated with poor outcomes and high mortality. However, identifying signs of stroke may be more difficult in critically ill patients.
UNASSIGNED: This study investigated the prevalence and independent predictors of in-hospital stroke among patients with acute alteration of consciousness in the medical intensive care unit (MICU) who underwent subsequent brain computed tomography (CT).
UNASSIGNED: This retrospective study enrolled eligible patients during the period 2007 - 2017. The alterations researched were radiologically confirmed acute ischaemic stroke (AIS) and intracerebral haemorrhage (ICH).
UNASSIGNED: Of 4 360 patients, 113 underwent brain CT. Among these, 31% had AIS, while 15% had ICH. They had higher diastolic blood pressures and arterial pH than non-stroke patients. ICH patients had higher mean (standard deviation (SD) systolic blood pressures (152 (48) v. 129 (25) mmHg; p=0.01), lower mean (SD) Glasgow Coma Scale scores (4 (3) v. 7 (4); p=0.004), and more pupillary abnormalities (75% v. 9%; p<0.001) than AIS patients. AIS patients were older (65 (18) v. 57 (18) years; p=0.03), had more hypertension (60% v. 39%; p=0.04), and more commonly presented with the Babinski sign (26% v. 9%; p=0.04). Multivariate analysis found that pupillary abnormalities independently predicted ICH (adjusted odds ratio (aOR) 26.9; 95% CI 3.7 - 196.3; p=0.001). The Babinski sign (aOR 5.1; 95% CI 1.1 - 23.5; p=0.04) and alkalaemia (arterial pH >7.4; aOR 3.6; 95% CI 1.0 - 12.3; p=0.05) independently predicted AIS.
UNASSIGNED: Forty-six percent of the cohort had ICH or AIS. Both conditions had high mortality. The presence of pupillary abnormalities predicts ICH, whereas the Babinski sign and alkalaemia predict AIS.
UNASSIGNED: The present study reports that almost half (46%) of critically ill patients with alterations of consciousness had an acute stroke. Of these, two-thirds had an acute ischaemic stroke (AIS), and one-third had an intracranial haemorrhage (ICH). Multivariate analysis revealed that a pupillary abnormality was a predictor for ICH and the Babinski sign was identified as a predictor of AIS.