急性心脑梗死临床特征及治疗转归的研究  

Study on Clinical Profile,Treatment and Outcomes of Patients with Acute Cardio-cerebral Infarction

作　　者：李雪 薛素芳[2] 王淳秀 张丽[4] 尹春琳[1] LI Xue;XUE Sufang;WANG Chunxiu(Xuanwu Hospital,Capital Medical University,Beijing 100053,China)

机构地区：[1]首都医科大学宣武医院心脏内科、国家老年疾病临床医学研究中心,北京100053 [2]首都医科大学宣武医院神经内科、国家神经疾病医学中心,北京100053 [3]首都医科大学宣武医院循证医学中心,北京100053 [4]首都医科大学宣武医院病案统计科,北京100053

出　　处：《医学研究杂志》2024年第1期131-135,共5页Journal of Medical Research

基　　金：北京市临床重点专科建设项目(京卫医2018-204)。

摘　　要：目的急性心脑梗死(cardio-cerebral infarction,CCI)是急性心肌梗死(acute myocardial infarction,AMI)合并急性缺血性脑卒中(acute ischemic stroke,AIS)的严重临床综合征,包括同步性CCI(synchronous CCI,SCCI)和异时性CCI(metachronous CCI,MCCI)。本研究拟探讨其临床特征、治疗现状及预后。方法采用单中心回顾性研究,纳入2014年1月~2021年12月首都医科大学宣武医院收治的CCI患者。采集分析人口统计学信息、临床特征、治疗和结局(全因死亡、MACE事件、mRS评分、出血事件)。结果研究纳入137例CCI患者,包括同步性CCI 28例和异时性CCI 109例。高血压、吸烟、糖尿病是最常见危险因素。患者心功能显著降低,42.9%KillipⅢ~Ⅳ级,40.0%左心室射血分数减低。AIS最主要病因为大动脉粥样硬化,入院NHISS评分为11.24±10.50。患者急诊再灌注治疗率低(29.2%),相比未接受急诊再灌注组患者,接受急诊再灌注组院内病死率较低(P=0.042)。院内全因死亡率高达27.0%,心力衰竭(43.8%)是最常见的MACE事件。出院时神经功能良好(mRS 0~2分)占34.3%。严重出血事件27例(19.7%),其中脑梗死出血转化19例(13.9%)。结论CCI的治疗仍面临挑战,患者急诊再灌注率低,抗栓方案个体差异大,临床预后差。未来亟需更多临床研究推动CCI治疗管理的优化。Objective Cardio-cerebral infarction(CCI)is a severe clinical syndrome in which acute myocardial infarction(AMI)and acute ischemic stroke(AIS)occurs simultaneously(synchronous CCI,SCCI)or successively(metachronous CCI,MCCI).The study aims to explore its clinical profile,management and outcomes.Methods This is a single-center retrospective study of inpatients with CCI who presented to Xuanwu hospital from January 2014 to December 2021.The study collected and analyzed demographic information,clinical profile,management and outcomes(all-cause death,MACE events,mRS scores,bleeding events).Results Totally 137 patients with CCI were enrolled in the study,including 28 SCCI and 109 MCCI.Hypertension,smoking and diabetes were prominent risk factors for CCI.The heart function decreased significantly,including 42.9%suffered KillipⅢ-Ⅳand 40.0%suffered decreased left ventricular ejection fraction.Large artery atherosclerosis was the most predominant etiology of AIS.The average NIHSS score was 11.24±10.50.The rate of emergency reperfusion therapy was low(29.2%).Compared to the group that did not received emergence reperfusion therapy,the patients received emergency reperfusion therapy had a lower in-hospital mortality(P=0.042).All-cause mortality occurred in up to 27.0%,including 11.7%cardiovascular death.Heart failure(43.8%)was the most frequent MACE events.34.3%patients had good neurological function(mRS 0-2)at discharge.27 patients(19.7%)experiencing major bleeding events,including 19 patients(13.9%)had the hemorrhagic transformation of AIS.Conclusion The CCI therapy still faces challenges,such as low reperfusion rate,differentiated antithrombotic options,and poor clinical prognosis.Large clinical research is need for promote the optimization of CCI treatment.

关 键 词：心脑梗死 心肌梗死 缺血性脑卒中 再灌注治疗 

分 类 号：R541.4[医药卫生—心血管疾病]