静脉溶栓对合并心房颤动的急性脑梗死患者的疗效观察  

Efficacy of intravenous thrombolysis for acute ischemic stroke patients with atrial fibrillation

作　　者：杨雯[1] 程兴[1] 胡传琛[1] 陆海鹏[1] 潘小玲[1] 邵慧军[1] 王建伟[1] 傅亚明 孔慧梅[1] 陈红芳[1] YANG Wen CHENG Xing HU Chuanchen et al(Department of Neurology, Jinhua Central Hospital, Jinhua 321000, China)

机构地区：[1]金华市中心医院神经内科,321000

出　　处：《浙江医学》2017年第18期1553-1556,共4页Zhejiang Medical Journal

摘　　要：目的观察合并心房颤动的急性脑梗死患者静脉溶栓的疗效。方法选择在4.5h内接受重组组织型纤溶酶原激活物(rt-PA)静脉溶栓治疗的163例急性脑梗死患者为研究对象,根据是否存在心房颤动分为房颤组39例和非房颤组124例。比较两组患者临床资料、溶栓后7d的美国国立卫生研究院卒中量表(NIHSS)评分、90d改良的Rankin量表(m RS)评分、颅内出血转化及症状性颅内出血的发生率,并采用logistic回归分析房颤对急性脑梗死静脉溶栓预后的影响。结果房颤组患者高龄(≥80岁)、颅内出血转化的比例均明显高于非房颤组(均P<0.01);但两组在症状性脑出血、90d预后良好(m RS评分0~1分)方面比较,差异均无统计学意义(均P>0.05)。logistic回归分析结果表明,入院时NIHSS评分(OR=0.822,95%CI:0.751~0.900,P<0.01)、肺部感染(OR=5.101,95%CI:1.739~14.959,P<0.01)与急性脑梗死静脉溶栓90d预后良好存在相关性;年龄(OR=1.096,95%CI:1.006~1.194,P<0.05)与颅内出血转化存在相关性;入院时NIHSS评分(OR=1.285,95%CI:1.061~1.556,P<0.05)是90d病死的独立危险因素。心房颤动与急性脑梗死静脉溶栓后的90d预后良好、颅内出血转化、病死等均未见相关(均P>0.05)。结论心房颤动所致急性脑梗死的比例随年龄增长逐渐增高。房颤不是急性脑梗死静脉溶栓预后良好的独立危险因素,通过溶栓治疗仍能获益,同时不增加症状性脑出血的发生率。Objective To assess the efficacy of intravenous thrombolysis for acute ischemic stroke（AIS） patients with atrial fibrillation （AF）. Methods One hundred and sixty-three AIS patients treated with recombinant tissue plasminogen activator （rt-PA） within 4.5 h after onset were enrolled, including 39 cases with AF （AF group） and 124 cases without AF （non-AF group）. Baseline characteristics, 7-d National Institute of Health Stroke Scale （NIHSS）, 90-d modified Rankin Scale （mRS）, hemorrhagic transformation （HT）, symptomatic intracranial hemorrhage（slCH） were compared between two groups. The correlation between AF and the prognosis of AIS patients after intravenous thrombolysis was analyzed by logistic regression analysis. Results The rate of elderly patients （≥80） in AF group was significantly higher than that in non-AF group [43.6% （17/39） vs. 14.5% （18/124）, P〈 0.01]. The rate of HT in AF group was higher than that in non-AF group [20.5%（8/39） vs. 6.5%（8/124）, P〈0.01]. There were no significant differencec in slCH and the 90-d favorable prognosis （mRS ≤ 1） between two groups （P 〉0.05）. Logistic regression analysis revealed that the baseline NIHSS score （0R=0.822, 95%C1：0.751-0.900, P〈0.01） and pulmonary infection （OR=5.101, 95%CI：1.739-14.959, P〈0.01） were associated with the prognosis at 90d after thrombolysis. The age was associated with the incidence of HT（OR=1.096, 95%CI：1.006-1.194, P〈0.05） and the baseline NIHSS score was associated with the 90-day mortality after thrombolysis （OR=1.285, 95%CI：1.061-1.556, P〈0.05）. AF was not associated with the 90-d prognosis, HT and 90-d mortality in AIS patients after thrombolysis （P 〉0.05）. Conclusion The risk of stroke attributed to AF is increased with age. The presence of AF may not have independent impact on the outcome of AIS, AIS patients with AF still can benefit from thrombolysis without increasing the occurrence of slCH.

关 键 词：脑梗死 心房颤动 静脉溶栓 预后 

分 类 号：R541.75[医药卫生—心血管疾病] R743.3[医药卫生—内科学]