大动脉粥样硬化性脑卒中与心脏功能关系的临床研究  

Relationships between Large Artery Atherosclerotic Stroke and Cardiac Function

作　　者：杨瑶 刘剑雄 张芸[1] 孔繁一 刘诗翔 Yao YANG;Jianxiong LIU;Yun ZHANG;Fanyi KONG;Shixiang LIU(Dept.of Psychosomatic Medicine,Mianyang Central Hospital,Mianyang Sichuan 621000;Dept.of Neurology,920th Hospital of People’s Liberation Army,Logistics Support Force,Kunming Yunnan 650032;Dept.of Neurology,The Affiliated Hospital of Yunnan University,Kunming Yunnan 650021,China)

机构地区：[1]绵阳市中心医院心身医学科,四川绵阳621000 [2]解放军联勤保障部队第920医院神经内科,云南昆明650032 [3]云南大学附属医院神经内科,云南昆明650021

出　　处：《昆明医科大学学报》2022年第11期107-111,共5页Journal of Kunming Medical University

基　　金：云南省应用基础研究基金青年项目(2012FD090)。

摘　　要：目的分析主动脉弓粥样硬化性脑卒中与颅内外动脉粥样硬化性脑卒中心脏功能的区别,探讨心脏功能对大动脉粥样硬化性脑卒中预后的影响。方法选取2014年1月至2017年10月在解放军联勤保障部队第920医院住院的首次急性缺血性脑卒中患者共846例,其中符合中国缺血性卒中亚型分型的大动脉粥样硬化患者552例,分为颅内外动脉粥样硬化组507例,主动脉弓粥样硬化组45例。分析主动脉弓粥样硬化性脑卒中与颅内外动脉粥样硬化性脑卒中心脏功能的区别,采用多因素回归分析心脏功能对卒中30 d预后的影响。结果(1)主动脉弓粥样硬化组患者左室射血分数[(55.14±9.41)vs(62.99±10.44),P<0.001]、左室缩短率(中位数28.00 vs 35.00,P<0.001)低于颅内外动脉粥样硬化组;主动脉弓粥样硬化组患者收缩末期容量大于颅内外动脉粥样硬化组(中位数45.00 vs 36.00,P=0.001);(2)大动脉粥样硬化性脑卒中患者,每搏输出量降低(OR=0.968,95%CI:0.951~0.985)、冠心病(OR=2.063,95%CI:1.050~4.055)增加30 d残疾风险;心输出量增加(HR=1.582,95%CI:1.170~2.139)、高尿酸血症(HR=5.411,95%CI:1.265~23.153)、年龄(HR=1.104,95%CI:1.023~1.192)增加30 d死亡风险。结论主动脉弓粥样硬化性脑卒中患者心脏收缩功能比颅内外动脉粥样硬化性脑卒中患者差。大动脉粥样硬化性脑卒中患者,冠心病、每搏输出量降低与30 d残疾独立相关;心输出量增加、年龄、高尿酸血症与30d死亡独立相关。Objective To analyze the difference in cardiac function between intracranial and extracranial atherosclerotic stroke and aortic arch atherosclerotic stroke,so as to investigate the effect of cardiac function on the prognosis of large artery atherosclerotic stroke. Methods A total of 846 patients with first-ever acute ischemic stroke from January 2014 to October 2017 in 920th Hospital of People’s Liberation Army,Logistics Support Force were selected. A total of 552 large artery atherosclerotic stroke patients who met the Chinese Ischemic Stroke Subclassification. Among these 507 were diagnosed with intracranial and extracranial atherosclerotic stroke and 45were diagnosed with aortic arch atherosclerotic stroke. To analyze the difference in cardiac function between intracranial and extracranial atherosclerotic stroke and aortic arch atherosclerotic stroke. The multivariate regression analysis was used to analyze the effect of cardiac function on the 30-day prognosis of stroke.Results The LVEF and LVFS in the aortic arch atherosclerosis group were lower than those in the intracranial and extracranial atherosclerosis group.The ESV in patients with aortic arch atherosclerosis was greater than that in the intracranial and extracranial atherosclerosis groups.In patients with large artery atherosclerotic stroke,decreased SV and coronary atherosclerotic heart disease increased the risk of 30-day disability;increased CO,hyperuricemia and age increased the risk of 30-day death.Conclusions The cardiac systolic function of patients with aortic arch atherosclerotic stroke is worse than that of patients with intracranial and extracranial atherosclerotic stroke.In patients with large artery atherosclerotic stroke,the decrease of SV and coronary atherosclerotic heart disease is independently associated with the 30-day disability,the increase of CO,age and hyperuricemia are independently associated with the 30-day death.

关 键 词：大动脉粥样硬化性脑卒中 心脏功能 残疾 死亡 

分 类 号：R743.3[医药卫生—神经病学与精神病学]