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脑卒中伴发睡眠障碍的影响因素研究
Study on the Influencing Factors of Stroke with Sleep Disorder
【作者】 张春玲;
【导师】 俞琼;
【作者基本信息】 吉林大学 , 公共卫生硕士(专业学位), 2017, 硕士
【摘要】 脑卒中又称脑中风或脑血管意外,是一种以突然晕倒、不省人事、语言不利、口歪眼斜、半身不遂等症状为主要临床表现的疾病,多由脑部出血或缺血性损伤所引起。在中老年人群中具有极高的患病率、致残率和致死率。大量临床数据表明,脑卒中伴发的睡眠障碍做为一种脑卒中的常见并发症,会极大的降低脑卒中病人的生存质量,极易引起抑郁、焦虑、神经功能退化等精神心理症状。但脑卒中伴发睡眠障碍的影响因素有哪些,学术界仍有争议。目的:探讨脑卒中伴发睡眠障碍的影响因素。为临床上诊断、治疗和预防脑卒中伴发睡眠障碍提供理论依据。方法:收集2016年6月至2017年6月吉林省某三甲医院神经内科所收治的出血性或缺血性脑卒中住院患者207例作为研究对象。采用自已设计的《脑卒中患者睡眠健康状况调查表》对所有样本进行一般社会人口学调查、临床资料调查和匹兹堡睡眠质量指数量表(PSQI)调查。将调查结果汇总分析,并对脑卒中患者的基本情况进行统计学描述。采用χ2检验对脑卒中伴发睡眠障碍的影响因素进行关联性分析,对经χ2检验有意义的变量再做多因素Logistic回归分析,筛选主要的影响因素。结果:研究结果显示,睡眠障碍组中,53人为男性,48人为女性,分别占组内人数的52.5%和47.5%。睡眠正常组中,61人为男性,45人为女性,分别占组内人数的57.5%和42.5%,P>0.05(双侧检验)表示不同性别组间差异无统计学意义。40~55岁年龄段的脑卒中患者中,有38.3%伴发有睡眠障碍,而在56~70年龄段中,该比例达到了43.1%,70岁以上的脑卒中患者伴发睡眠障碍的比例最高,高达74.5%,不同年龄组间差异具有统计学意义(P<0.05)。已婚患者中,有57人患有睡眠障碍,患病率为42.5%。而独身患者中则有44人患有睡眠障碍,患病率高达60.3%。进一步分析结果显示,脑卒中伴发睡眠障碍的患病率与患者的婚姻状况具有相关性(P<0.01)。不同文化程度组别内,睡眠障碍组和睡眠正常组的人数和所占比例基本都在50%左右,不同文化程度组间差异无统计学意义(P>0.05)。从事体力劳动的患者睡眠障碍的患病率约为39.7%,而从事脑力劳动的患者睡眠障碍患病率则超过60%,脑卒中伴发睡眠障碍的患病率与患者的职业具有相关性(P<0.01)。少数民族患者与汉族患者之间,在睡眠障碍患病率上的差异无统计学意义(P>0.05)。低收入的32位卒中患者中,有30位都患有睡眠障碍,患病率高达93.8%。远远高于中等收入患者(35.3%)和高收入患者(37%),且差异有统计学意义(P<0.01)。脑卒中伴发的睡眠障碍患病率与患者的病程分期、卒中类型、卒中解剖部位、是否患有心脏病、卒中分期和神经功能是否失常有相关性(P<0.05)。神经功能异常的脑卒中患者相较于神经功能正常的脑卒中患者,其睡眠障碍的患病率显著提高。而各实验室检测数据与脑卒中伴发睡眠障碍患病之间并没有相关性(P>0.05)。结论:1.脑卒中患者其年龄越高、单身、从事脑力劳动、低收入的患者越容易发生睡眠障碍;2.从患者的卒中类型来看,缺血性脑卒中的患者相对于出血性脑卒中的患者,更易发生睡眠障碍;3.从卒中解剖部位来看,脑卒中病灶部位位于下丘脑位置的患者伴发睡眠障碍的几率最高,其次是病灶部位位于脑干部位的脑卒中患者,再次是病灶部位位于小脑的卒中患者,其睡眠障碍仅仅比病灶部位位于额叶和基底节区的患者稍高;4.从卒中分期角度来看,随着病程的不断发展,患者伴发睡眠障碍的几率是先上升后下降的;5.神经功能异常的脑卒中患者相较于神经功能正常的脑卒中患者,其睡眠障碍的患病率显著提高;
【Abstract】 Stroke,also known as cerebrovascular accident,is a kind of disease caused by bleeding or ischemic brain injury with the main clinical manifestations of sudden unconscious faint,language barrier,and hemiplegia.In the middle-aged and aged people,the stroke has a very high incidence,morbidity and mortality.A large number of clinical data shows that the sleep disorder is a common complication of stroke,which will greatly reduce the quality of life of stroke patients and very easily cause the mental symptoms such as depression,anxiety and nerve function degradation.But the influence factors which cause sleep disorders in stroke is still controversial in academic circles.Objective:To explore the influence factors of stroke with sleep disorders.For clinical diagnosis,treatment and prevention of stroke with sleep disorders.Methods:To collect 207 cases of hospitalized patients with ischemic or hemorrhagic stroke treated by Jilin University third hospital,(China-Japan Union Hospital)neurology from 2016 June to June,2017 as the research sample.Using the sleep health questionnaire of stroke patients for all samples containing general social demographic survey,clinical data investigationand Pittsburgh Sleep Quality Index scale(PSQI).Adopt SPSS22.0 all statistical analysis software,count data describe the adoption rate,composition ratio,comparison between groups by chi-square test.The description of the measurement data according to conform to fall along the mean + /-standard deviation or the median and quartiles method,comparison between groups using t test or rank and inspection.Influence factors analysis by using single factor and multi-factor unconditioned Logistic regression.Results:Results show that a group of sleep disorders,53 human male,48 women,accounting for 52.5% of the number in the group and 52.5% respectively.Sleep in the normal group,61 are male,45 of them women,accounted for 57.5% and 42.5% of the number of group,there was no statistically significant difference between the different gender groups(P > 0.05).40 ~ 55 years of age in stroke patients,and 38.3% with sleep disorders,in 56-70 age group,the proportion reached 43.1%,more than 70-year-old has the highest percentage of cerebral apoplexy patients with comorbid sleep disorders,as high as 74.5%.It can be seen that the onset of stroke with sleep disorders ratio is increased with the increase of age growing,statistically significant difference between different age groups,and extremely significant difference(P < 0.01).Married patients,there are 57 people suffer from sleep disorders,the prevalence was 42.5%.And single patients there were 44 people suffer from sleep disorders,the prevalence rate is as high as 60.3%.Further analysis shows that the incidence of comorbid sleep disorders and stroke patient’s marital status has very significant correlation(P < 0.01).Groups of different cultural levels,the number of sleep disorder group and normal group and the proportion of basic it is around 50%,there was no statistically significant difference between the degree of different cultural groups(P > 0.05).Engaged in physical labor of the incidence of sleep disorders in patients with about 39.7%,while engaged in mental Labour incidence of sleep disorders in patients with more than 60%,the incidence of comorbid sleep disorders and stroke in patients with occupational has extremely significant correlation(P < 0.01).Ethnic minority patients between patients with the han nationality,on the incidence of sleep disorder was not found to have larger difference(P > 0.05).Low-income 32-bit stroke patients,there are 30 are suffering from a sleep disorder,incidence of a disease as much as 93.8%.Is much higher than middle-income patients(35.3%)and high income patients(37%),and extremely significant difference(P < 0.01).Through the analysis of clinical data,we found that patients with comorbid sleep disorders and stroke progression in installment,the types of stroke,stroke anatomical site,whether suffering from heart disease,stroke,staging,and whether neural function disorder have significant correlation(P < 0.05).And the laboratory test data with cerebral apoplexy with no significant correlation between incidence of sleep disorder(P > 0.05).Conclusion:1.Stroke patients with their older,single,engaged in mental labor,low-income patients more prone to sleep disorders;2.From the patient’s type of stroke,patients with ischemic stroke are more likely to develop sleep disorders than patients with hemorrhagic stroke;3.Stroke anatomical sites,the location of the lesion in the hypothalamus stroke patients with sleep disorders most likely,followed by the lesion in the brain stem parts of the stroke patients,again in the lesion is located in the cerebellum stroke patients,The sleep disorders were slightly higher than those in the frontal and basal ganglia at the lesion site;4.From the perspective of stroke staging,with the continuous development of the disease,the probability of patients with sleep disorders first increased and then decreased;5.Stroke patients with neurological dysfunction Compared with patients with neurological normal stroke,the prevalence of sleep disorders was significantly increased;
- 【网络出版投稿人】 吉林大学 【网络出版年期】2018年 04期
- 【分类号】R743.3;R740
- 【被引频次】5
- 【下载频次】384