中国现代神经疾病杂志 ›› 2025, Vol. 25 ›› Issue (5): 381-389. doi: 10.3969/j.issn.1672-6731.2025.05.004

• 多中心研究 • 上一篇    下一篇

2 急性期液体容量负荷与穿支动脉粥样硬化病相关卒中临床结局分析:多中心前瞻性队列研究

胡海洲, 李胜德, 倪俊*()   

  1. 100730 中国医学科学院 北京协和医学院 北京协和医院神经科
  • 收稿日期:2025-04-14 出版日期:2025-05-25 发布日期:2025-06-05
  • 通讯作者: 倪俊
  • 基金资助:
    四大慢病重大专项(2023ZD0515700)

Association between acute - phase volume load and clinical outcome in branch atheromatous disease-related stroke: a multicenter prospective cohort study

Hai-zhou HU, Sheng-de LI, Jun NI*()   

  1. Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
  • Received:2025-04-14 Online:2025-05-25 Published:2025-06-05
  • Contact: Jun NI
  • Supported by:
    Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0515700)

摘要:

目的: 探讨急性期液体容量管理对穿支动脉粥样硬化病相关卒中患者预后的影响。方法: 纳入穿支动脉粥样硬化病相关卒中多中心前瞻性队列研究(BAD-study)中20所综合性卒中中心2021年6月至2023年6月诊断与治疗的345例穿支动脉粥样硬化病相关卒中患者,记录入院后3 d内日均入量和日均净入量,采用改良Rankin量表评估发病后90 d神经功能预后,单因素和多因素Logistic回归分析筛查获得极好预后的影响因素。结果: 多因素Logistic回归分析显示,日均入量 < 2000 ml(OR = 0.345,95%CI:0.133 ~ 0.897;P = 0.029)、日均净入量 > 500 ml(OR = 0.457,95%CI:0.222 ~ 0.940;P = 0.033),以及高龄(OR = 0.961,95%CI:0.929 ~ 0.994;P = 0.021)、糖尿病(OR = 0.494,95%CI:0.245 ~ 0.995;P = 0.048)、既往服用他汀类药物(OR = 0.159,95%CI:0.037 ~ 0.684;P = 0.014)、入院时美国国立卫生研究院卒中量表评分较高(OR = 0.688,95%CI:0.613 ~ 0.772;P = 0.000)、入院后抗凝治疗(OR = 0.416,95%CI:0.203 ~ 0.850;P = 0.016)、早期神经功能恶化(OR = 0.142,95%CI:0.059 ~ 0.343;P = 0.000)是穿支动脉粥样硬化病相关卒中患者未获得极好预后的危险因素。结论: 穿支动脉粥样硬化病相关卒中患者急性期保持日均入量2000 ~ 2500 ml及日均净入量0 ~ 500 ml有可能获得更好的神经功能预后,提示此类患者急性期液体容量管理应平衡避免低血容量与预防容量超负荷的双重目标,个性化指导补液方案。

关键词: 缺血性卒中, 动脉粥样硬化, 容量管理(非MeSH词), 危险因素, Logistic模型, 多中心研究, 前瞻性研究, 队列研究

Abstract:

Objective: To explore the impact of acute-phase volume load on clinical outcome in patients with branch atheromatous disease (BAD)-related stroke. Methods: A total of 345 patients with BAD-related stroke were enrolled from June 2021 to June 2023 in the multicenter prospective cohort study (BAD-study) involving 20 comprehensive stroke centers across China. Neurological functional outcome at 90 d was assessed by modified Rankin Scale (mRS). Univariate and multivariate Logistic regression analyses were performed to identify factors influencing 90 d excellent outcome. Results: Multivariate Logistic regression analysis showed that a daily average intake of < 2000 ml (OR = 0.345, 95%CI: 0.133-0.897; P = 0.029), a daily average net intake of > 500 ml (OR = 0.457, 95%CI: 0.222-0.940; P = 0.033), advanced age (OR = 0.961, 95%CI: 0.929-0.994; P = 0.021), diabetes mellitus (OR = 0.494, 95%CI: 0.245-0.995; P = 0.048), previous statin use (OR = 0.159, 95%CI: 0.037-0.684; P = 0.014), higher baseline National Institutes of Health Stroke Scale (NIHSS) score (OR = 0.688, 95%CI: 0.613-0.772; P = 0.000), anticoagulant therapy (OR = 0.416, 95%CI: 0.203-0.850; P = 0.016) and early neurological deterioration (OR = 0.142, 95%CI: 0.059-0.343; P = 0.000) were risk factors for failture to achieve excellent outcome. Conclusions: For BAD-related stroke patients, a daily average intake of 2000-2500 ml and a daily average net intake of 0-500 ml in the acute-phase may have a better prognosis, suggesting that acute-phase volume management should balance the dual goals of avoiding hypovolemia and preventing volume overload, with individualized fluid rehydration strategies.

Key words: Ischemic stroke, Atherosclerosis, Volume management (not in MeSH), Risk factors, Logistic models, Multicenter study, Prospective studies, Cohort studies