Prognostic factors of hospital mortality in patients with acute cerebrovascular disease requiring mechanical ventilation_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 ZHANG Jiuzhi , WAN Xianyao , WU xiangdong

Center Intensive Care Unit ， The First Affiliated Hospital of Dalian Medical University.Dalian ， Liaoning ， 116011 ， China Corresponding author ： ZHANG Jiu-zhi ， E-mail ： zhjzh9@tom.com;

Corresponding author：

ZHANG Jiuzhi, Email: zhjzh9@tom.com

Keywords：

Mechanical ventilation; Cerebrovascular diseases; Hospital mortality; Prognostic factors

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Objective To investigate the outcome and prognostic factors of hospital mortality in patients with acute cerebrovascular disease requiring mechanical ventilation.Methods Data from 94 patients with acute cerebrovascular disease in central intensive care unit(ICU) were collected and retrospectively analyzed.Prognostic factors of hospital mortality were analyzed by univariate statistics and multivariate logistic regression.Results Hospital mortality was 53.2%(50/94).There was significance diference in parameters such as APACHE II score，blood glucose，lengh of hospital stay，lengh of ICU stay，time of mechanical ventilation，incision of trachea，lung infections，lesion loci and its naturer between the survival and non-survival groups（all P lt;0.05）.Multivariate logistic regression revealed that blood glucose，lung infections，diseased region under tentorium of cerebellum，time of mechanical ventilation were independent prognostic risk factors of hospital mortality(all P lt;0.05).Whereas the lengh of ICU stay was protective factor(P lt;0.05).Conclusion The hospital mortality is considerably high in patients with acute cerebrovascular disease requiring mechanical ventilation. The prognostic factors such as blood glucose and lung infections should be evaluate cautiously and prevented aggressively.

Citation： ZHANG Jiuzhi,WAN Xianyao,WU xiangdong. Prognostic factors of hospital mortality in patients with acute cerebrovascular disease requiring mechanical ventilation. Chinese Journal of Respiratory and Critical Care Medicine, 2008, 08(4): 281-285. doi: Copy

1.	2 Mayer SA，Copeland D，Bernardini GL，et a1.Cost and outcome of mechanical ventilation for life-threatening stroke.Stroke，2000，31：2346-2353. 3 Hamidon BB，Nabil I，Raymond AA.Risk factors and outcome of dysphagia after an acute ischaemic stroke.Med J Malaysia，2006，61：553-557.
2.
3.
4.	Ovary C，Suzuki K，Nagy Z．Regional differences in incidence rates，outcome predictors and survival of stroke.Neuroepidemiology，2004，23：240-246.
5.	Karapanaylotides T，Piechowski-Jozwiak B，vail MeUeg G，et al．Stroke patterns，etiology，and prognosis in patients with diabetes mellitus．Neurology，2004，62：1558-1562.
6.	Heuschmann PU，Kolominsky-Rabas PL，Misselwitz B，et al.Predictors of in-hospital mortality and attributable risks of death after ischemic stroke：the German Stroke Registers Study Group.Arch Intern Med，2004，164：1761-1768.
7.	Kazumi K，Yasuyuki I，Takeshi I，et al.Hyperglycemia independently increases the risk of early in acute spontaneous intracerebral hemorrhage.Journal of the Neurological Sciences，2007，255：90-94.
8.	McCowen KC，Malhottra A，Bistrian BR.Stress-induced hyperglycemia.Crit Care，2001，17：107-124.
9.	Christensen H，Boysen G．Blood glucose increases early after stroke onset：a study on serial measurements of blood glucose acute stroke．Eur J Neurol，2002，9：297-301.
10.	Leigh R，Zaidat OO，Suri MF，et al.Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy.Stroke，2004，35：1903-1907.
11.	Song EC，Chu K，Jeong SW，et al.Hyperglycemia exacerbates brain edema and perihematomal cell death after intracerebral hemorrhage.Stroke，2003，34：2215-2220.
12.	Garg R，Chaudhuri A，Munschauer F，et al.Hyperglycemia，insulin，and acute ischemic stroke：a mechanistic justification for a trial of insulin infusion therapy.Stroke，2006，37：267-273.
13.	Van den Berghe G，Schoonheydt K，Becx P，et al.Insulin therapy protects the central and peripheral nervous system of intensive care patients.Neurology，2005，64：1348-1353.
14.	Federico B，Allison S，Federico G，et al.The Effect of Intensive Insulin Therapy on Infection Rate，Vasospasm，Neurologic Outcome，and Mortality in Neurointensive Care Unit After Intracranial Aneurysm Clipping in Patients With Acute Subarachnoid Hemorrhage.Neurosurg Anesthesiol，2007，19：156-160.
15.	黄伟，李晓枫，万献尧，等.长期机械通气患者的预后因素分析.中国呼吸与危重监护杂志，2004，3：167-169.
16.	黄伟，秦咏梅，万献尧，等.老年长期机械通气患者的预后影响因素.大连医科大学学报，2004，26：197-199.
17.	Cho DY，Wang YC.Comparison of the APACHEⅢ，APACHEⅡ and Glasgow Come Scale in the acute head injury for prediction of mortality and functional outcome.Intensive Care Med，1997，23：77-84.
18.	孟新科.APACHE评分系统的研究现状及展望.中国急救医学杂志，2001，21：430-431.
19.	Michael Z，Rolando B.Tracheostomy in the critically ill patient：who，when，and how?.Clinical Pulmonary Medicine.2006，13：111-120.

1. 2 Mayer SA，Copeland D，Bernardini GL，et a1.Cost and outcome of mechanical ventilation for life-threatening stroke.Stroke，2000，31：2346-2353. 3 Hamidon BB，Nabil I，Raymond AA.Risk factors and outcome of dysphagia after an acute ischaemic stroke.Med J Malaysia，2006，61：553-557.
2.
3.
4. Ovary C，Suzuki K，Nagy Z．Regional differences in incidence rates，outcome predictors and survival of stroke.Neuroepidemiology，2004，23：240-246.
5. Karapanaylotides T，Piechowski-Jozwiak B，vail MeUeg G，et al．Stroke patterns，etiology，and prognosis in patients with diabetes mellitus．Neurology，2004，62：1558-1562.
6. Heuschmann PU，Kolominsky-Rabas PL，Misselwitz B，et al.Predictors of in-hospital mortality and attributable risks of death after ischemic stroke：the German Stroke Registers Study Group.Arch Intern Med，2004，164：1761-1768.
7. Kazumi K，Yasuyuki I，Takeshi I，et al.Hyperglycemia independently increases the risk of early in acute spontaneous intracerebral hemorrhage.Journal of the Neurological Sciences，2007，255：90-94.
8. McCowen KC，Malhottra A，Bistrian BR.Stress-induced hyperglycemia.Crit Care，2001，17：107-124.
9. Christensen H，Boysen G．Blood glucose increases early after stroke onset：a study on serial measurements of blood glucose acute stroke．Eur J Neurol，2002，9：297-301.
10. Leigh R，Zaidat OO，Suri MF，et al.Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy.Stroke，2004，35：1903-1907.
11. Song EC，Chu K，Jeong SW，et al.Hyperglycemia exacerbates brain edema and perihematomal cell death after intracerebral hemorrhage.Stroke，2003，34：2215-2220.
12. Garg R，Chaudhuri A，Munschauer F，et al.Hyperglycemia，insulin，and acute ischemic stroke：a mechanistic justification for a trial of insulin infusion therapy.Stroke，2006，37：267-273.
13. Van den Berghe G，Schoonheydt K，Becx P，et al.Insulin therapy protects the central and peripheral nervous system of intensive care patients.Neurology，2005，64：1348-1353.
14. Federico B，Allison S，Federico G，et al.The Effect of Intensive Insulin Therapy on Infection Rate，Vasospasm，Neurologic Outcome，and Mortality in Neurointensive Care Unit After Intracranial Aneurysm Clipping in Patients With Acute Subarachnoid Hemorrhage.Neurosurg Anesthesiol，2007，19：156-160.
15. 黄伟，李晓枫，万献尧，等.长期机械通气患者的预后因素分析.中国呼吸与危重监护杂志，2004，3：167-169.
16. 黄伟，秦咏梅，万献尧，等.老年长期机械通气患者的预后影响因素.大连医科大学学报，2004，26：197-199.
17. Cho DY，Wang YC.Comparison of the APACHEⅢ，APACHEⅡ and Glasgow Come Scale in the acute head injury for prediction of mortality and functional outcome.Intensive Care Med，1997，23：77-84.
18. 孟新科.APACHE评分系统的研究现状及展望.中国急救医学杂志，2001，21：430-431.
19. Michael Z，Rolando B.Tracheostomy in the critically ill patient：who，when，and how?.Clinical Pulmonary Medicine.2006，13：111-120.

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