Yearly Report on CVA Patients

(1)

Ⅰ. 서 론

1994 2002 8

2

, 2003

169

.

Ⅱ. 관찰대상 및 항목

A. 대상

2003 1 1 12 31

2 ,

임영남, 심성용, 고호연, 박정섭, 정승민, 이시형, 전찬용, 김동우, 박종형

경원대학교 부속 한방병원

Yearly Report on CVA Patients

Young-Nam Yim, Sung-Yong Sim, Ho-Yeon Ko, Jung-Sup Park, Seung-Min Jung, Si-Hyung Lee, Dong-Woo Kim, Chan-Yong Jun, Chong-Hyeong, Park

Oriental Hospital of Kyung-Won University

Objectives Objectives Objectives

Objectives :::: This study was prepared for investigating the clinical features of stroke patients.

Methods Methods Methods

Methods :::: We retrospectively reviewed the medical records of 169 patients who were admitted to Dept.

of Internal Medicine, College of Oriental Medicine, Kyung-Won University with a diagnosis of stroke from Jan. 1, 2003 to Dec. 31, 2003.

Results Results Results

Results :::: Ischemic stroke(include TIA, 85.2%) was more common than hemorrhagic stroke(14.8%).

The incidence in male was 46.7%, in female was 53.3% and the most prevalent age group is over-sixties. Cerebral infarction was most frequently noticed in MCA territory and lacunar-inf., hemorrhage in putamen. Hypertention, the most preceding diseases, followed by diabetes mellitus. The rate of recurrence was 30.18%. Cerebral infarction and cerebral hemorrhage was much occurred in acting. The most patients visited the hospital after 5 days. The most common symptoms in admission time were motor weakness and speech disorder. The complication was mostly urinary tract infection. Physical treatment from onset, in cerebral infarction was 9.14 days and in cerebral hemorrhage was 18.33 days.

Conclusions Conclusions Conclusions

Conclusions :::: Our study on CVA patients was similar to previous studies from 1994 to 2002. In most cases, western and oriental treatment and medicine were given synthetically.

Key Key

Key Key Words:Words:Words: CVA, cerebral infarction, cerebral hemorrhage.Words:

(2)

(Brain CT), (MRI)

169 . ,

.

B. 조사항목

, , ,

, ,

, , ,

, ,

,

, , ,

, , , ,

,

, ,

1994~2000, 2002 .

Ⅲ. 결과

1. 진단별 분포

, , (TIA)

169 127 (75.1%),

25 (14.8%), TIA 17 (10.1%) .

79 (46.7%), 90 (53.3%) ,

60 60 (35.5%), 70 47 (27.8%), 50 30 (17.8%), 80 18 (10.7%), 40 12 (7.1%), 30 2 (1.2%) (Table 1).

2. 뇌경색 및 뇌출혈의 부위별 발생빈도

127

MCA Lacunar Inf.(39 30.7%) ,

25 IVH & ICH(6 , 24.0%) (Table 2).

3. 과거력 상 선행질환

100 (59.17%) ,

42 (24.85%) ,

30 (17.75%) (Table 3).

Diagnosis

total

Cb-inf. ICH TIA

Sex (persons(%))

Male Female

68(53.5%) 59(46.5%)

7(28.0%) 18(72.0%)

4(23.5%) 13(76.5%)

79(46.7%) 90(53.3%) Age(M±SD)

total(persons)

67.12±10.84 127

62.32±11.77 25

62.18±10.78 17

65.91±11.11 169

Cb-inf. ICH

ACA MCA PCA VA, BA, Pontine Br.

Cbll Lacunar Inf.

border line etc.

tatal

3 (2.4) 39 (30.7)

3 (2.4) 20 (15.7)

4 (3.1) 39 (30.7)

9 (7.1) 10 (7.9) 127 (100)

putamen thalamus putamen & thalamus

subcortex pons IVH IVH & ICH

etc.

tatal

2 (8.0) 5 (20.0) 4 (16.0) 4 (16.0) 2 (8.0) 1 (4.0) 6 (24.0)

1 (4.0) 25 (100.0)

(3)

4. 고혈압, 뇌졸중 및 당뇨의 가족력

177 49 (28.99%), 45

(26.63%), 24 (14.20%), 9 (5.32%) (Table 4).

5. 재발률

169 118 (69.82%)

41 (24.26%), 3 10

(5.92%) .

6. 계절 및 월별 발생빈도

1 12 (7.10%), 2 13 (7.69%), 3 16 (9.47%), 4 14 (8.28%), 5 16 (9.47%), 6 12 (7.10%), 7 13 (7.69%), 8 17 (10.06%), 9 16 (9.47%), 10 14 (8.28%), 11 16 (9.47%),

12 10 (5.92%) , , 46

(27.22%), 42 (24.85%), 35 (20.71%) .

7. 유발정황

55 (39.57%),

39 (28.06%) (Table 5).

Diagnosis

total

Cb-inf. ICH TIA

HTN DM Hyperlipidemia

Heart Diz CVA

etc.

75(44.38) 37(21.89) 6(3.55) 10(5.92) 41(24.26)

4(2.37)

14(8.28) 2(1.18) 0(0.00) 3(1.78) 1(0.59) 4(2.37)

11(6.51) 3(1.78) 1(0.59) 0(0.00) 7(4.14) 0(0.00)

100(59.17) 42(24.85)

7(4.14) 13(7.69) 49(28.99)

8(4.73) Values are mean±standard deviation.

*: P<0.05 by Wilcoxon signed ranks test vs. baseline

Diagnosis

total

Cb-inf. ICH TIA

HTN

P*

M B total

9(5.33) 6(3.55) 11(6.51) 26(15.38)

4(2.37) 9(5.33) 3(1.78) 16(9.47)

3(1.78) 3(1.78) 1(0.59) 7(4.14)

16(9.47) 18(10.65)

15(8.88) 49(28.99)

DM

P M B total

3(1.78) 5(2.96) 13(7.69) 21(12.43)

0(0.00) 1(0.59) 1(0.59) 2(1.18)

0(0.00) 1(0.59) 0(0.00) 1(0.59)

3(1.78) 7(4.14) 14(8.28) 24(14.20)

Heart Disease

P M B total

4(2.37) 4(2.37) 1(0.59) 9(5.32)

0(0.00) 0(0.00) 0(0.00) 0(0.00)

4(2.37) 4(2.37) 1(0.59) 9(5.32)

CVA

P M B total

12(7.10) 10(5.92) 5(2.96) 27(15.98)

2(1.18) 6(3.55) 1(0.59) 9(5.32)

3(1.78) 3(1.78) 3(1.78) 9(5.32)

17(10.06) 19(11.24) 9(5.32) 45(26.63)

*) P : paternal line M : maternal line B : brother

(4)

8. 발병 후 입원까지의 경과시간

169 24 38 (22.49%), 1-2

48 (28.40%), 3-5 22 (13.02%), 5 61

(36.09%) .

9. 입원경로

169 78 (46.15%),

59 (34.91%), 18

(10.65%), 7 (4.14%), 7

(4.14%) .

10. 입원기간

167 10 67

(39.64%), 11-20 38 (22.49%), 21 30 24 (14.20%) 31- 60 25 (14.79%), 61 15

(8.88%) .

11. 발병 후 물리치료 개시시기

169 111 (65.68%)

. 133 87

(68.50) , 1 32

(25.20%) , 2 38 (29.92%), 3 4

(3.15%), 4 1 (0.79%),

12 (9.45%) .

25 21 (84.00%)

, 1 4 (16.00%), 2

9 (36.00%), 3 8 (32.00%) .

12. 입원당시 의식상태와 예후의 관계

148

(87.57%), 9 (5.33%), 4

(2.37%) , ,

6 (3.55%), 1 (0.59%),

1 (0.59%) .

13. 입 퇴원당시의 증상

169 138 (81.65%)

MMP(Muscular motor power) Gr. , 67 (39.64%),

MMP Gr. , 71 (42.01%) .

120 (71.01%), 90 (53.25%), 64 (37.87%), 55 (32.54%), 54 (31.95%),

· 47 (27.81%), 37 (21.89%)

.

, , , ,

, , , , ,

, , , , , , ,

.

119 (70.41%)

, 24 (14.20%), 95

(56.21%) . 67 (39.641%),

35 (20.71%), 21 (12.43%), 19 (11.24%), 13 (7.69%) (Table 6).

Cb-inf. ICH TIA total

sleeping or after getting up acting

resting drinking after overwork

conversation total

33(31.43) 37(35.24) 23(21.90) 3(2.86) 1(0.95) 8(7.62) 105(100.00)

4(21.05) 10(52.63)

1(5.26) 1(5.26) 1(5.26) 2(10.53) 19(100.00)

2(13.33) 8(53.33) 2(13.33) 0(0.00) 2(13.33) 1(6.67) 15(100.00)

39(28.06) 55(39.57) 26(18.71) 4(2.88) 4(2.88) 11(7.91) 139(100.00)

(5)

14. 합병증

169 35 (20.71%)

, 17 (10.06%), 6 (3.55%)

2 (1.18%) .

15. 음주및 흡연

169 53 (31.36%)

, 17 (10.06%), 99 (58.58%)

. 53 (31.36%), 8

(4.73%), 108 (63.91%) .

20.03±9.79( / ) , 7 (4.14%), 34 (20.12%),

12 (7.10%) .

81.35±

75.23( / ) , (360 ) 1

28 (16.57%), 12 (7.10%),

13 (7.69%) .

16. 입 퇴원 시 혈압

JNC-VII

120mmHg 80

mmHg 120-130mmHg

80-89mmHg , 140-

159mmHg 90-99mmHg 1 ,

160mmHg 100mmHg

2 .

9 (5.33%), Pre-HTN 39

(23.08%), 1 65 (38.46%), 2

56 (33.14%) , 25

(14.79%), Pre-HTN 58 (34.32%), 1

78 (46.15%), 2 8 (4.73%) .

Admission Discharge

Cb-inf. ICH TIA total Cb-inf. ICH TIA total

motor paralysis

none slight severe

22(13.02) 51(30.18) 54(31.95)

1(0.59) 11(6.51) 13(7.69)

8(4.73) 9(5.33)

31(18.34) 71(42.01) 67(39.64)

34(20.12) 75(44.38) 18(10.65)

3(1.78) 16(9.47) 6(3.55)

13(7.69) 4(2.37)

50(29.59) 95(56.21) 24(14.20) facial paralysis

dysphasia aphasia dysphagia

dyspnea sensory disturbance disturbance of consciousness

disorientation headache dizziness diplopia nausea, vomitting

chest discomfort palpitation

yawn fever cough insomnia

tremor constipation

uracratia urinary retention

maldigestion

19(11.24) 96(56.80) 9(5.33) 34(20.12)

8(4.73) 9(5.33) 5(2.96) 20(11.83) 39(23.08) 45(26.63) 4(2.37) 30(17.75)

15(8.88) 13(7.69) 42(24.85)

14(8.28) 19(11.24) 34(20.12) 2(1.18) 74(43.79)

10(5.92) 5(2.96) 14(8.28)

6(3.55) 16(9.47)

5(2.96) 12(7.10)

4(2.37) 2(1.18) 4(2.37) 3(1.78) 8(4.73) 8(4.73)

1(0.59) 3(1.78) 2(1.18) 9(5.33) 2(1.18) 3(1.78) 7(4.14)

13(7.69) 2(1.18) 1(0.59) 7(4.14)

8(4.73) 1(0.59) 1(0.59) 1(0.59) 2(1.18)

8(4.73) 11(6.51)

6(3.55) 5(2.96) 3(1.78) 3(1.78) 2(1.18) 4(2.37) 6(3.55) 1(0.59) 3(1.78)

5(2.96)

25(14.79) 120(71.01)

15(8.88) 47(27.81) 13(7.69) 13(7.69) 9(5.33) 23(13.61) 55(32.54) 64(37.87) 4(2.37) 37(21.89) 23(13.61) 18(10.65) 54(31.95) 18(10.65) 26(15.38) 47(27.81) 3(1.78) 90(53.25)

12(7.10) 6(3.55) 26(15.38)

15(8.88) 57(33.73)

8(4.73) 8(4.73) 3(1.78) 4(2.37) 3(1.78) 18(10.65)

4(2.37) 10(5.92)

4(2.37) 3(1.78) 4(2.37) 3(1.78) 3(1.78) 4(2.37) 3(1.78) 4(2.37) 1(0.59) 30(17.75)

9(5.33)

1(0.59)

4(2.37) 10(5.92)

5(2.96) 2(1.18) 2(1.18) 1(0.59) 2(1.18) 3(1.78) 4(2.37) 1(0.59)

2(1.18) 1(0.59) 2(1.18)

4(2.37) 2(1.18) 1(0.59) 2(1.18)

2(1.18)

1(0.59)

1(0.59) 1(0.59)

1(0.59)

19(11.24) 67(39.64) 13(7.69) 10(5.92) 5(2.96) 7(4.14) 5(2.96) 21(12.43)

9(5.33) 11(6.51)

4(2.37) 3(1.78) 5(2.96) 4(2.37) 3(1.78) 6(3.55) 4(2.37) 6(3.55) 1(0.59) 35(20.71)

11(6.51) 1(0.59) 3(1.78)

(6)

T

.(Table 7)

Mean±S.D. p value AS-BP(mmHg)* 144.20±24.02

0.000 DS-BP(mmHg) 129.88±15.96

AD-BP(mmHg) 88.402±10.65

0.000 DD-BP(mmHg) 82.426±8.966

*) AS-BP : systolic blood pressure at admission DS-BP : systolic blood pressure at discharge AD-BP : diastolic blood pressure at admission DD-BP : diastolic blood pressure at discharge

17. 심전도

169 81 (48.21%) ,

72 (42.60%), 68 (40.24%), 10 (5.92%),

9 (5.33%), 8 (4.73%),

6 (3.55%), 5 (2.96%), 1

(0.59%), 18 (10.65%) .

18. 입원당시 혈청지질의 측정

169 166

. Total-Cholesterol 198.39±38.45

/ , Triglyceride 144.21±136.61

/ , HDL-cholesterol 48.07±9.47 / , LDL- cholesterol 122.58±40.09 / ,

2.77±2.01 , HDL 46.98±28.45

.

NCEP ATP III 62

(37.35%), 52 (31.33%),

52 (31.33%) ,

(Atherogenic Index) 108 (65.06%), 3 58 (34.94%) .

19. 입원당시 혈당의 측정

169 149

. 102.04±43.93 /

, 2 154.63±66.51 /

. 80 (53.69%) ,

69 (46.31%) .

20. 입원 기간 중의 한 양방협진

169 20 (11.83%)

, Foley catheter 11 (6.51%), Nelatone catheter 10 (5.92%), O2 9 (5.33%), Levin-tube 9 (5.33%), Suction 7 (4.14%), Enema 5 (2.96%), Cannula 2 (1.2%), .

169 , (

) 165 (97.63%) .

114 (67.46%)

, 98 (57.99%)

, ACE inhibitors,

Ca antagonist, Ca antagonist, diuretics, beta blocker 89 (52.66%), 66 (39.05%), 63 (37.28%), 31 (18.34%), 13 (7.69%) .

sulfonylureas, alfa-glucosidase inhibitors, biguanides, RI, NPH 25 (14.79%), 8 (4.73%), 1 (0.59%), 16 (9.47%), 12 (7.10%)

.

20 (11.83%), 15

(8.88%) .

Normal saline 137 (81.07%), Glycerol 28 (16.57%), Dextrose water 14 (8.28%), Hartmann dextrose 5 (2.96%), Hartmann solution 4

(2.37%), Dextrose saline 4 (2.37%), Fravasol

13 (7.69%) .

21. 처방활용빈도

(TIA )

, , , ,

, ,

(7)

.

,

, , ,

, , .

Ⅳ. 고찰

9

1970 1

10,

,

11.

, 20

12,13

,

14-16

, 10

17-19

.

70% ^4-8

.

, ,

20.

169 127

(75.1%), 25 (14.8%), TIA 17 (10.1%) ,

79 (46.7%), 90 (53.3%) , 60

80 ⁵, ⁶,

7, ⁸ .

MCA Lacunar

Inf. ^1-8

, 25 IVH & ICH

.

59.17% ,

17.75% .

21.

, ^1-8

. 24 (14.20%) 1998 ⁵ 5.2%, 1999 ⁶ 7.3%, 2000 ⁷ 7.4%, 2002 ⁸ 12%

.

3 51 (30.18%)

3

23 5-8

.

8 , 3 5 9 11

1-8

.

‘ ’

‘ ’ ², ⁷

1,3-6,8

, ^1-8

.

‘ 24

’, ‘1-2 ’, ‘3-5 ’, ‘5 ’

3, ⁸ , ⁴, ⁵, ⁶, ⁷,

, ‘ ’, ‘

’, ‘ ’, ‘ ’

4, ⁵, ⁶, ⁸ ,

60.94% .

10 67 (39.64%), 11-20 38 (22.49%), 21-30 24 (14.20%) 31- 60 25

(14.79%), 61 15 (8.88%) .

, vital sign ,

, 169 111

(8)

(65.68%) .

133 87 (68.50) ,

1 32 (25.20%) , 2 38 (29.92%),

3 4 (3.15%), 4 1 (0.79%),

12 (9.45%) .

25 21 (84.00%)

, 1 4 (16.00%), 2

9 (36.00%), 3 8 (32.00%) .

18.33 , 9.14 .

148

, 9 , 4 ,

, 6

, 1 , 1 .

MRI CT

,

, , ,

,

, ^1-8

.

, , , , ,

, ,

, , , ,

, , .

.

2 ,

, ,

24.

35 (20.71%) ,

2002 ⁸ .

1-8.

53 (31.36%) , 17 (10.06%),

99 (58.58%) . 53

(31.36%), 8 (4.73%), 108

(63.91%)

25,26 .

· ,

9 (5.33%), Pre-HTN 39 (23.08%),

1 65 (38.46%), 2 56

(33.14%) , 25

(14.79%), Pre-HTN 58 (34.32%), 1

78 (46.15%), 2 8 (4.73%) .

T

.

JNC 27 120/80mmHg

130/80 mmHg

.

169 81 (48.21%)

,

, ,

1-8

.

169

166 , NCEP ATP III28

Total-Cholesterol, Triglyceride, LDL-

cholesterol , 62

(37.35%), 52 (31.33%),

52 (31.33%) ,

3 ²⁹ 58 (34.94%)

.

30,

62.66% .

2-4

(9)

149 . 80 (53.69%) , 69 (46.31%) .

, .

20 (11.83%) , Foley

catheter, Nelatone catheter, O2 , Levin-tube, Suc-

tion .

, (

) 165 (97.63%) .

67.46%

, 57.99% ,

ACE inhibitors, Ca antagonist, Ca antagonist, diuretics, beta blocker 52.66%, 39.05%, 37.28%, 18.34%, 7.69%

. sulfonylureas, alfa-glucosidase inhibitors, biguanides, RI, NPH 14.79%, 4.73%,

0.59%, 9.47%, 7.10% .

20 (11.83%), 15 (8.88%)

.

Normal saline 81.07%, Glycerol 16.57%, Dextrose water 8.28%, Hartmann dextrose 2.96%, Hartmann solution 2.37%, Dextrose saline 2.37%, Fravasol 7.69% .

1-8

, Glycerol

,

· . (TIA )

, , , ,

, ,

, , ,

.

,

, , ,

30.6%,

32.0% ^1-8

. , , ,

, , ,

1-8

.

Ⅴ. 결과

2003 1 1 12 31 1

169

.

1. 169 127

(75.1%), 25 (14.8%), TIA 17

(10.1%) , MCA Lacunar Inf.(39

30.7%) , IVH &

ICH (6 , 24.0%) . 79

(46.7%), 90 (53.3%) ,

60 , 70 , 50 , 80 .

2. , ,

, ,

30.18% .

3. ,

, 8 , 3·5·9·11

, · , ,

.

4. 5

, , 60.94% .

5. 10 ,

9.14 ,

18.33 .

(10)

6. , , ,

, , , ,

, , ,

.

7. 169 35 (20.71%)

, , ,

.

8. 31.36% , 10.06%,

58.58% . 31.36%,

4.73%, 63.91% .

9. 5.33%,

Pre-HTN 23.08%, 71.60%,

, 14.79%, Pre-HTN

34.32%, 50.98% ,

.

10. 48.21% ,

, , , ·

.

11. 37.35%,

31.33%, 31.33%

, 65.06%,

3 34.94%

. 12.

53.69% , 46.31%

.

13. 11.83%, 97.63%

. Foley catheter, Nelatone

catheter, O2 ,

, ,

, Normal saline

.

14. , , ,

, ,

, 30.6%,

32.0% .

Ⅵ. 참고문헌

1. , , . 226

. . 1995;16(2):

17-35.

2. , . 226

. . 1997;18(1):

5-23.

3. , . 290

. . 1997;18(2):

223-44.

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( ). . 1998;19(2):59-74.

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( ). . 2000;21(3):337-47.

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( ). . 2001;22(3):321-31.

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( ). . 2001;2(1):1-8.

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(2002 ). . 2003;24(3):

604-15.

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11. C PW arlow. Epidemiology of stroke. Lancet.

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. . 1982;12(2):

359-65.

(11)

. .1980;23:620.

16. , , .

. CT .

. 1982;25:174.

17. , , .

10 .

. 1992;43(5):637-44.

18. , , .

. . 1988;31(4):409-419.

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1993;8(4):281-9.

20. , . 20

. . 2000.

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1996;4: 221-8.

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23. Schmidt EV, Smimov VE, Ryabova VS. Results of the seven-year prospective study of stroke patients. Stroke. 1988;19:942-9.

24. , , .

. . 2000;21(4):227-

35.

25. , , .

. 1997;19(2):240-57.

26. , , .

. . 2000;21(4):104-11.

27. Aram V. Chobanian, George L. Bakris, Henry R. Black et al. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA. 2003;289(19):2560-72.

28. The Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Cholesterol Education Program. National Heart, Lung, and Blood Institute. National Institutes of Health. NIH Publication No. 02-5215, September 2002. Cir- culation. 2002.;106(25):3143-421.

29. , .

Leptin ,

. . 2000;33

(1):49-58.

30. , , .

. . 1998;19(2):60-80.

31. . Classification of acute ischemic stroke.

1 . 1998:7-27.

32. WHO Task Force on Stroke and Other Cerebral Disorders. Recommandations on stroke prevention, diagnosis, and theraphy : report of the WHO Task Force on Stroke and Other Cerebral Disorders. Stroke. 20:1407-31.