急性重症自发性蛛网膜下腔出血并发脑心综合征的临床分析  

Clinical characteristics of severe acute spontaneous subarachnoid hemorrhage complicated by cerebrocardiac syndrome

作　　者：王红芹[1] 陈光忠[2] 董孟琪 秦琨[2] 彭超[2] 

机构地区：[1]广东省人民医院、广东省医学科学院广东省心血管病研究所心电功能室,广州510080 [2]广东省人民医院、广东省医学科学院广东省心血管病研究所神经外科,广州510080

出　　处：《中华神经医学杂志》2017年第7期715-718,共4页Chinese Journal of Neuromedicine

基　　金：（1）基金项目：广东省科技计划项目（20138021800179、2016A020212008）（2）基金项目：广州市科技计划项目（2014J4100042）

摘　　要：目的探讨急性重症自发性蛛网膜下腔出血（sAH）并发脑心综合征（ccs）患者的心电图特征及预后情况。方法回顾性研究广东省人民医院自2012年1月至2015年12月收治的80例重症自发性SAH患者的心电图及临床资料，分析比较Hunt—HessⅣ级与Ⅴ级患者心肌酶谱及心电图变化情况及预后。结果80例患者中初次心电图异常者76例，占95％。其中ST-T改变68例，T波改变45例，QT间期延长30例，心律异常26例，传导阻滞11例，异常Q波9例；有2种以上波形改变者63例。Hunt-Hess分级Ⅳ级和Ⅴ级患者中，Q-T间期延长、心律异常、传导阻滞、异常Q波的发生率及GOS预后评分差异均有统计学意义（P〈0．05）。所有患者人院2h内心肌酶谱基本正常，Hunt-HessV级患者肌酸激酶略有升高，但与Hunt—HessⅣ级患者比较差异无统计学意义（P〉0．05）。结论ST—T及T波改变是急性重症自发性SAH并发CCS的常见心电图表现，CCS的发生是影响急性重症自发性SAH预后的重要影响因素。Objective To explore the electrocardiogram （ECG） characteristics and prognoses of patients with severe acute spontaneous subarachnoid hemorrhage （SAH） complicated by cerebrocardiac syndrome （CCS）. Methods The ECG characteristics and clinical data of 80 patients with severe SAH admitted to our hospital from January 2012 to December 2015 were retrospectively analyzed. The myocardial enzymes, serum troponin T and ECG changes in patients of Hunt-Hess grading IV and V were compared. Results ECG abnormalities at the first time were noted in 76 patients, accounting for 95%. Wave changes （more than two kinds） were noted in 63 patients. ST-T changes were noted in 68 patients, T wave changes in 45, QT interval prolongation in 30, cardiac arrhythmia in 26, conduction block in 11, and abnormal Q wave in 9. The occurrence rates of Q-T interval prolongation, cardiac arrhythmia, conduction block, abnormal Q wave and Glasgow outcome scale （GOS） scores between patients of Hunt-Hess grading IV and V were significantly different （P〈0.05）. The myocardial enzyme levels were normal and serum troponin T level slightly increased in patients of Hunt-Hess grading V within 2 h of admission. Conclusion ST and T waves changes are the common electrocardiogram manifestations of acute severe SAH patients with CCS; CCS is the important prognostic factors of acute severe SAH patients.

关 键 词：蛛网膜下腔出血 脑心综合征 心电图 预后 

分 类 号：R743.35[医药卫生—神经病学与精神病学]