Improved survival of stroke patients during the 1980s. The Minnesota Stroke Survey.
Improved survival of stroke patients during the 1980s. The Minnesota Stroke Survey.
复制标题
20 世纪 80 年代中风患者的生存率有所提高。
DOI：
10.1161/01.str.26.1.1
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发表时间：
1995
期刊：
影响因子：
8.3
通讯作者：
Blackburn,H
中科院分区：
文献类型：
--
作者：
Shahar,E;McGovern,PG;Sprafka,JM;Pankow,JS;Doliszny,KM;Luepker,RV;Blackburn,H
背景和目的在美国，脑卒中死亡率下降的根本原因还不清楚，并且一直是争论的主题。这项研究是为了确定在20世纪80年代住院的中风患者的生存率是否发生了变化，从而有助于在此期间中风死亡率的下降。我们从明尼阿波利斯的医院获得了出院诊断列表，圣保罗大都会区，并根据国际疾病分类确定所有出院诊断代码为急性脑血管疾病的住院，第9次修订版：在每次调查中随机抽取50%的年龄在30至74岁之间的男性和女性进行详细的医疗记录提取。然后使用标准化的中风标准集来验证整个20世纪80年代的急性中风事件。每三个时期队列的住院中风患者（1980年，1985年和1990年）进行了为期至少2年的全因死亡率endpoint.ResultsA共1853例患者符合急性中风的最低标准：564例在1980年，598例在1985年，691例在1990年。在控制年龄的情况下，1990年中风后2年内的死亡率比1980年低约40%。1990年（与1980年相比）男性和女性2年死亡的相对比值分别为0.65（95%置信区间，0.47至0.89）和0.60（95%置信区间，0.42至0.85）。短期（28天）以及在此期间存活的中风患者的生存率明显提高。根据卒中亚型的分析显示，缺血性卒中，特别是无明显心源性栓塞的卒中的生存率提高在很大程度上解释了总体趋势。在昏迷状态下入院的中风患者的预后并没有改变，在这decade.ConclusionsDespite没有任何明确的重大进展，在急性中风治疗，中风患者的生存大大改善，在20世纪80年代。这一意想不到的显著趋势的根本原因仍然不确定，但可能包括改善中风患者的支持和康复护理以及疾病自然史的变化。
Background and PurposeThe underlying reasons for the decline in stroke mortality in the United States are not well understood and have been the subject of ongoing debate. This study was undertaken to determine whether survival of hospitalized stroke patients has changed during the 1980s, thereby contributing to the decline in stroke mortality during that period.MethodsFor the years 1980, 1985, and 1990, we obtained listings of discharge diagnoses from hospitals in the Minneapolis-St Paul metropolitan area and identified all hospitalizations with a discharge diagnosis code of acute cerebrovascular disease according to theInternational Classification of Diseases, 9th Revision.A 50% random sample of men and women aged 30 to 74 years was selected in each survey for detailed medical record abstraction. Standardized sets of criteria for stroke were then used to validate acute stroke events throughout the 1980s. Each of the three period cohorts of hospitalized stroke patients (1980, 1985, and 1990) was followed for at least 2 years for all-cause mortality end point.ResultsA total of 1853 patients met minimal criteria for acute stroke: 564 patients in 1980, 598 patients in 1985, and 691 patients in 1990. Controlling for age, the odds of death within 2 years after stroke were approximately 40% lower in 1990 than in 1980. The relative odds of 2-year death in 1990 (versus 1980) were 0.65 (95% confidence interval, 0.47 to 0.89) and 0.60 (95% confidence interval, 0.42 to 0.85) for men and women, respectively. The improved survival was evident in the short term (28 days) as well as for stroke patients who survived that period. Analysis according to stroke subtype revealed that improved survival of ischemic stroke and specifically of stroke with no apparent cardioembolic source largely accounted for the overall trend. The prognosis of stroke patients who were admitted in a comatose state has not changed during that decade.ConclusionsDespite the absence of any clear major advances in acute stroke therapy, survival of stroke patients substantially improved during the 1980s. The underlying reasons for this unexpected yet remarkable trend remain uncertain but may include improved supportive and rehabilitative care of stroke victims as well as a change in the natural history of the disease.