急性蛛网膜下腔出血患者入院心电图异常对住院预后的判断作用  

Admission Electrocardiograph Predicts Poor in-Hospital Outcome in Patients with Acute Subarachnoid Hemorrhage

作　　者：黄永平 张勇 王德国[2] 卜莉萍 李二军 HUANG Yongping;ZHANG Yong;WANG Deguo;BU Liping;LI Erjun(Hefei Technology College,Hefei,Anhui 238000;Yijishan Hospital of Wannan Medical Collegee,Wuhu,Anhui 241001,China)

机构地区：[1]合肥职业技术学院,安徽合肥238000 [2]皖南医学院附属弋矶山医院,安徽芜湖241001

出　　处：《九江学院学报（自然科学版）》2020年第1期90-95,共6页Journal of Jiujiang University：Natural Science Edition

基　　金：2016年度国家自然科学基金资助项目(编号81670301);安徽省大学优秀青年人才支持计划(编号GXQZD2016181-W.D.)重点项目;安徽省教育厅教学团队项目(编号2018jxtd143);合肥职业技术学院校级科研项目(编号201914SKB011);合肥职业技术学院精品资源共享课程项目(编号2018JPKC002)的成果之一。

摘　　要：目的蛛网膜下腔出血(SAH)患者心电图异常频率高,研究确定任何特定的心电图异常是否与住院患者的不良结果相关。方法该研究从270例非创伤性SAH患者中选择145例作为研究对象。对所有SAH发病72h内的患者进行标准的体表心电图检查。根据出院时住院死亡率或神经功能恶化程度(世界神经外科医师联合会,WFNS分级),将所有患者分为预后好组和预后不良组。结果不良结果(n=29)患者心率明显升高(93.52±22.23 vs 78.42±18,p<0.01),QTC延长(458.17±44.88 vs 436.89±43.46,p=0.027)。心电图异常的发生率较高,包括ST段(90%对44%,p<0.01)和左室肥大(28%对10%,p<0.03)。多重logistic回归发现ST异常(优势比2.811;95%可信区间1.014-7.789;p<0.05)、心率异常(优势比4.207;95%可信区间1.063-16.651;p<0.05)和WFNS分级(优势比4.741;95%可信区间1.949~11.531;p=0.001)是与住院不良预后相关的显著独立变量。结论ST段压低或抬高以及入院时心率异常,与住院SAH患者临床预后不良的风险增加密切相关。Objective High frequency of electrocardiographic(ECG)abnormalities were seen in patients with subarachnoid hemorrhage(SAH).The aim of this study was to determine whether any specific ECG abnormalities were associated with adverse outcomes of inpatients.Methods A total of 145 patients who selected from 270 cases with non-traumatic SAH were included in this study.A standard surface ECG was assessed for all patients within 72 hours of SAH onset.All patients were stratified into Good or Poor outcome groups according to the mortality or neurological worsening(World Federation of Neurological Surgeons,WFNS class)when discharged from hospital.Results The patients in poor outcome(n=29)had significantly higher heart rate(93.52±22.23 vs 78.42±18,p<0.01),more prolonged QTc(458.17±44.88 vs 436.89±43.46,p=0.027).There were higher frequency of ECG abnormalities including ST segment(90%vs 44%,p<0.01)and left ventricular hypertrophy(28%vs 10%,p=0.05).Multiple logistic regression identified abnormal ST(odds ratio,2.811;95%CI,1.014-7.789;p=0.05),abnormal heart rate(odds ratio,4.207;95%CI,1.063-16.651;p=0.05)and WFNS class(odds ratio,4.741;95%CI,1.949-11.531;p=0.01)as the significant independent variables associated with in-hospital poor outcome.Conclusion ST segment depression or elevation and abnormal heart rate on admission were strongly and independently associated with increased risk of poor clinical outcomes in-hospital patients with SAH.

关 键 词：蛛网膜下腔出血 住院预后 心电图异常 ST段异常 QTc间隔 

分 类 号：R743.35[医药卫生—神经病学与精神病学]