The occurrence of stroke in patients and a variety of underlying diseases during the hospitalization are associated with the treatment, they often result in the aggravation of disease, poor prognosis, and medical disputes. Theoretically, the timeliness of diagnosis and treatment of in-hospital strokes are superior to those outside hospitals, but it still has the widespread delay in the actual diagnosis and treatment. This article reviews the possible causes and mechanisms of in-hospital stroke in order to raise awareness of prevention of in-hospital stroke, prevent and eliminate the potential risks of in-hospital stroke.

Objective To investigate the clinical features,etiology and risk factors of the inpatients with ischemic stroke in the Department of Cardiology.Methods The medical records of the inpatients with ischemic stroke and the inpatients in a control group were collected retrospectively.The demographics,vascular risk factors,clinical features,and other related factors were compared in both groups.Multivariate logistic regression analysis was used to analyze the independent risk factors for in-hospital ischemic stroke in the Department of Cardiology.Results A total of 2 789 inpatients in departments of cardiology were enrolled,and 26 of them (0.93％) had in-hospital stroke.One hundred thirty inpatients from 2 763 patients without in-hospital stroke were used randomly as control cases.The proportions of the inpatients of hypertension (73.08％ vs.50.77％ ; x2=4.348,P=0.037),atrial fibrillation (50.00％ vs.15.38％; x2=15.56,P=0.000),infection (30.77％ vs.7.69％ ; x2 =11.304,P =0.003),smoking (46.15％ vs.21.54％ ; x2 =6.886,P =0.009),alcohol (26.92％ vs.11.54％ ;x2 ＝ 4.233,P =0.040),previous stroke history (19.23％ vs.4.61％ ;x2 =7.062,P =0.008),and taking anti-hypertensive drugs (42.31％ vs.21.54％ ;x2 =4.985,P =0.026),as well as systolic blood pressure (143.43 ± 18.59 mm Hgvs.129.52 ± 23.52 mm Hg; t =3.209,P=0.003; 1 mmHg =0.133 kPa),diastolic blood pressure (88.77± 11.35 mm Hg vs.77.55± 14.60 mmHg; t=2.421,P =0.020),and homocysteine levels (19.27 ± 11.08 μnol/L vs.15.30 ±5.25 μmol/L; t =2.814,P =0.006) in the stroke group were significantly higher than those in the control group in the Department of Cardiology.Multivariate logistic regression analysis showed that atrial fibrillation (odds ratio [OR] 3.310,95％ confidence interval [CI] 1.207-9.076; P =0.020),infection (OR 3.270,95％ CI 1.024-10.438; P =0.045),systolic blood pressure (OR 1.023,95％ Cl 1.002-1.045; P =0.031),and homocysteine level (OR 1.089,95％ CI 1.009-1.175; P =0.029) were the independent risk factors for in-hospital ischemic stroke in the Department of Cardiology.Conclusions Atrial fibrillation,infection,systolic blood pressure,and high homocysteine levels are the independent risk factor for in-hospital ischemic stroke in the Department of Cardiology.Active intervention and control these risk factors may have great significance for reducing its risk.

Objective To investigate the predictive factors of no early improvement and their impact on outcomes after alteplase intravenous thrombolysis in patients with acute ischemic stroke.Methods Between March 2015 and March 2016,the clinical data of the patients with acute ischemic stroke admitted to the Department of Neurology,Fengcheng People's Hospital and treated with intravenous thrombolysis were analyzed retrospectively.The National Institutes of Health Stroke Scale score declined ＜4 within 24 h after admission was defined as no early improvement,and the modified Rankin Scale score ＞ 2 at 3 months was defined as poor outcome.Multivariate logistic regression analysis was used to determine predictors of no early improvement and their impact on outcomes.Results A total of 85 patients were enrolled,aged 63.88 ± 11.12 years,63 (74.1％) were males;45 (52.9％) had no early improvement,40 (47.1％) had early improvement;48 (56.5％) had good outcome at 3 months,and 37 (43.5％) had poor outcome.The proportion of hypertension (73.3％ vs.45.0％;x2 =7.083,P =0.008) and diabetes mellitus (33.3％ vs.15.0％;x2 =3.826,P =0.051),as well as the baseline fasting blood glucose (8.74 ± 4.28 mmol/L vs.6.87 ±2.57 mmol/L;t=2.471,P=0.016) in the no early improvement group were significantly higher than those in the early improvement group.Multivariate logistic regression analysis showed that hypertension alone was an independent risk factor for no early improvement after intravenous thrombolysis with ateplase (odds ratio 2.896,95％ confidence interval 1.108-7.570;P =0.030).The proportion of early improvement in the good outcome group was significantly higher than that in the poor outcome group (58.3％ vs.32.4％;x2=5.626,P=0.018).Multivariate logistic regression analysis showed that early improvement might be a independent predictor of good outcome (odds ratio 3.187,95％ confidence interval 1.099-9.242;P =0.033).Conclusion In patients treated with alteplase thrombolytic therapy,hypertension was an independent risk factor for no early improvement,and no early improvement was independently associated with poor outcome.