伴有心房纤颤的急性脑梗死患者的短期预后及其相关因素的分析  

Analysis on short-term prognosis and correlated risk factors in acute cerebral infarction patients with nonvalular atrial fibrillation

作　　者：杨帆[1] 关珂[1] 孙林琳[1] 司承庆[1] 潘玉君[1] 

机构地区：[1]哈尔滨医科大学附属第一医院神经内科,150001

出　　处：《临床神经病学杂志》2014年第3期189-192,共4页Journal of Clinical Neurology

摘　　要：目的：探讨伴非瓣膜性心房纤颤（房颤）的急性脑梗死患者的短期预后及其相关因素。方法调查197例伴有房颤的急性脑梗死患者的临床资料，并进行CHA2DS2-VASc评分。在发病后3个月时，采用改良Rankin量表（mRS）评定患者的预后。比较预后良好与预后不佳患者的临床资料和CHA2DS2-VASc评分，对有统计学意义的因素行 Logistic 回归分析。结果本组患者中189例（95．4％）的 CHA2DS2-VASc评分＞1分。预后良好93例（47．2％），预后欠佳104例（52.8％），仅抗凝达标组患者预后的差异有统计学意义（P＜0.05）。预后良好与预后欠佳患者的年龄、性别、卒中史、美国国立卫生研究院卒中量表（NIHSS）评分、抗凝达标及CHA2DS2-VASc评分的差异有统计学意义（P＜0.05～0．01）。多因素Logistic回归分析显示， NIHSS评分、CHA2DS2-VASc评分（OR＝1．32，95％CI：1．16～1．51，P＝0.002）和标准的抗凝治疗（OR＝0．49，95％CI：0．28～0．89，P＝0.018）为预后的独立预测因素。结论伴有房颤的急性脑梗死患者短期预后欠佳， NIHSS评分、CHA2DS2-VASc评分和抗凝达标是短期预后的独立预测因素。Objective To explore the short-term prognosis and its correlated factors in acute cerebral infarction patients with nonvalular atrial fibrillation .Methods The clinical data of 197 acute cerebral infarction patients with atrial fibrillation were investigated .The CHA2DS2-VASc score was calculated .And recovery was assessed by modified Rankin Scale（mRS） at 3 months follow-up.The clinical data and CHA2DS2-VASc score were compared between good prognosis and poor outcome in patients .Variables that reached statistical significance were analyzed using logistic regression analysis .Results One hundred and eighty-nine（95.4%） patients had a CHA2DS2-VASc score 〉1.Good prognosis and poor outcome were found in 93（47.2%） and 104（52.8%）patients respectively. Only the difference of prognosis in therapeutic anticoagulation group reached statistical significance （P〈0.05）.The differences between good prognosis and poor outcome in age , sex, previous stroke ,National Institute of Health stroke scale（NIHSS） score, antithrombotic treatment and CHA2DS2-VASc score were statistical significant （P〈0.05 -0.001）.Multivariate logistic regression model results suggested that NIHSS score ,CHA2DS2-VASc score （OR =1.32,95%CI：1.16 -1.51,P=0.002） and therapeutic anticoagulation （OR=0.49,95%CI：0.28 -0.89,P=0.018） were independent predictors of stroke prognosis .Conclusion The short-term prognosis in acute cerebral infarction patients with nonvalular atrial fibrillation is not so good , and the NIHSS score, CHA2DS2-VASc score and therapeutic anticoagulation are the independent predictors of it .

关 键 词：脑梗死 心房纤颤 预后 CHA2DS2-VASc评分 

分 类 号：R743.3[医药卫生—神经病学与精神病学]