| Objectives:To analysis the risk factors of acute stroke patient with stress ulcer respectively, and to analysis the possible relationship and interaction between the various factors, the aim of the study is to provide clinicians a theoretical basis for prevention and treatment of acute stroke patients with stress ulcer, and to explore individual prevention and treatment programs according to characteristics of patients.Methods:After Establishing related risk factors questionnaire of acute stroke patients with stress ulcer. We screened the in-hospital patients within three years from January1,2010to December31,2011in Department of Neurology of Shandong Provincial Hospital, who were diagnosed with acute stroke. We filtered the patients with stress ulcer, recorded their detailed clinical data in accordance with the risk factors questionnaire, and recorded negative cases as controls as well. Finally, We did statistical analysis based on the positive and negative cases, compared the impact of stress ulcer to prognosis, then concluded potentially relevant risk factor of acute stroke patients with stress ulcer.Results:From2010to2012, There was a total of2462cases of in-hospital patients with acute stroke in neurology ward,2026cases in it complied with the standards, and within which a total of111(5.48%) cases combined with stress ulcer, with a age distribution from31to90.The most common time of ulcer onset is72hours to a week after stroke (36.04%).Bleeding were controlled in101cases, while10patients died due to uncontrolled gastrointestinal bleeding, the mortality rate was9.0%. The ulcer patients had different clinical manifestations. Hematemesis, melena or extracting of brown gastric juice in24cases, drop in blood pressure or shock caused by gastrointestinal bleeding the in14cases, abdominal discomfort symptoms including hiccups, nausea and vomiting, abdominal pain,bloating, loss of appetite, burning felling in16patients,57cases had no clinical symptoms except positive occult blood in defecate.(1) Compared ulcer group and non-ulcer group, a separate analysis of age, sex, hypertension, diabetes, and prophylactic anticoagulation treatment more than90days, smoking, drinking. fasting, nasal feeding,consciousness state, difference between the two groups was statistically different (all p-value are less than0.05).(2) The ulcer incidence and onset form between cerebral hemorrhage group and cerebral infarction group were in a statistically significant difference (p<0.05).(3) Brain lesions, the site of bleeding in the brain hemorrhage, cerebral infarction locations including the internal carotid artery system and the incidence rates of vertebral-basilar artery, were in statistically significant difference (p<0.05).(4) Compared the group which used prophylactic ulcer for treatment or prevention with the group which who had none, the incidence of ulcer were in statistically significant difference (p<0.05).(5) The ulcer group had significantly longer ward stay and worse prognosis than the non-ulcer group significantly(p<0.05).Conclusion:(1) Stress ulcer in acute stroke patients, induce significantly worse prognosis and higher mortality, longer hospital stay, attention should be paid to the ulcer prevention.(2) Age, sex, hypertension, diabetes, and prophylactic anticoagulation treatment more than90days, smoking, drinking,.fasting, nasal feeding, impaired consciousness are all independent risk factors of stress ulcer. In clinical treatments, patients with these high-risk factors above, prophylaxis treatments should be considered before ulcers occur according to characteristics of patients.(3) Two weeks after stroke, there is still a considerable proportion of patients with ulcer occurs,that is to say, stress ulcer prevention and treatment of high-risk populations should be extended to two weeks later.(4) Analysis of possible mechanisms of stress ulcer in acute stroke patients. To sum up,which Includes gastric mucosal barrier damage for gastric mucosal ischemia and exceed gastric acid secretion caused by dysfunction of the autonomic nervous system and mental stress, due to the brain local damage. We can verify the specific pathogenesis mechanism of stress ulcer in acute stroke patients by monitoring levels of hormone of brain and secreted factors of stomach. |
