合并阵发性心房颤动的急性缺血性脑卒中患者临床特征及预后研究  

The study of clinical characteristics and prognosis in acute ischemic stroke patients with paroxysmal atrial fibrillation

作　　者：李欣彦 汤颖[2] 孙红伟[2] 李芳[2] 王萍 赵景波 LI Xin-yan;TANG Ying;SUN Hong-wei(Department of Epidemiology, School of Public Health, Harbin Medical University, Harbin, Heilongjiang 150081 , China)

机构地区：[1]哈尔滨医科大学公共卫生学院流行病学教研室,黑龙江哈尔滨150081 [2]哈尔滨医科大学附属第一临床医学院神经内科卒中病房,黑龙江哈尔滨150001

出　　处：《中华全科医学》2019年第8期1403-1407,共5页Chinese Journal of General Practice

基　　金：黑龙江省自然科学基金项目(D201235)

摘　　要：目的探讨合并阵发性房颤的急性缺血性脑卒中患者的临床特征及预后情况。方法前瞻性收集2017年1-12月在哈尔滨医科大学附属第一医院卒中病房治疗的731例急性缺血性脑卒中患者的基本信息。根据患者的疾病史、入院心电图检查、住院期间心电监测确定有无房颤及类型。随访出院结局和3个月预后。将合并阵发性房颤组分别与无房颤组及合并持续性房颤组对比临床特征及预后。结果①合并阵发性房颤与无房颤的患者相比,入院时神经功能受损更严重(P<0.001),患者严重神经功能受损比例更高(P=0.002)。合并心力衰竭、冠心病、心肌梗死、肾功能异常的比例更高(均P<0.05)。合并阵发性房颤是出院结局及出院3个月预后的危险因素,OR(95%CI)为2.190(1.111,4.316)、3.399(1.701,6.791)。②合并阵发性房颤与合并持续性房颤的患者相比,患心脏瓣膜性疾病的比例更低(P<0.001),住院期间病情明显缓解比例更高(P=0.017)。结论合并阵发性房颤相比无房颤患者起病时病情重、伴发疾病更多;相比于持续性房颤患者,仅心脏瓣膜性疾病比例更低;相比于无房颤患者,合并阵发性房颤是急性缺血性脑卒中患者出院结局及3个月预后不良的危险因素。Objective To investigate clinical characteristics and prognosis in acute ischemic stroke(AIS) patients with paroxysmal atrial fibrillation(AF). Methods We prospectively collected 731 patients with AIS who were hospitalized in the Stroke Unit, First Affiliated Hospital of Harbin Medical University from January to December in 2017. AF and its type were defined according to the patient’s disease history, admission electrocardiogram and cardiac monitoring during hospitalization. Follow-up prognostic status at discharge and three months. The clinical features and prognosis of paroxysmal AF group and non-AF group, paroxysmal AF group and persistent AF group were compared. Results ①Compared with AIS patients without AF, patients with paroxysmal AF had more severe neurological impairment at admission(P<0.001). A higher proportion of patients with severe neurological impairment(P=0.002). The proportion of heart failure, coronary heart disease, myocardial infarction, and abnormal renal function was higher(all P<0.05). Increased risk of adverse prognosis at discharge and three months [OR(95% CI):2.190(1.111, 4.316), 3.399(1.701, 6.791)] in patients with paroxysmal AF.②Compared with AIS patients with persistent AF, patients with paroxysmal AF had a lower proportion of heart valvular disease(P<0.001), and a significantly higher rate of remission during hospitalization(P=0.017). Conclusion Paroxysmal AF patients with AIS have more serious neurological deficits, more associated diseases than AIS patients without AF. Only patients with paroxysmal AF had a lower proportion of valvular heart disease compared with patients with persistent AF. Comparing with patients without atrial fibrillation, paroxysmal atrial fibrillation was a risk factor for discharge and three-months poor prognosis in AIS patients.

关 键 词：急性缺血性脑卒中 阵发性房颤 持续性房颤 临床特征 预后 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R541.75[医药卫生—临床医学]