老年急性缺血性脑梗死患者心电图的变化与病情及近期预后的关系
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摘要
目的探讨老年急性缺血性脑梗死(CIS)患者心电图的变化情况,分析其与病情及预后的关系。方法入选2013年1月至2016年12月广西壮族自治区民族医院住院治疗的132例老年急性CIS患者为观察对象。于发病48 h内、第7天进行12导联心电图检查,分析心电图异常与梗死分型、病情严重程度及预后的关系。以出院时改良Rankin's评分为依据,测评患者预后不良的独立预测指标。结果 83例(62. 88%)发生心电图异常。心电图异常的主要类型为S-T段异常,其次为心律失常。检出心电图异常者,其脑梗死病情较未检出心电图异常者明显加重,差异有统计学意义(P <0. 05)。心电图异常≥2次检出者,其病情较仅发病48 h内检出异常及仅发病第7天检出异常者明显加重,差异有统计学意义(P <0. 05)。发病至入院时间较短、OCSP分型为完全前循环梗死、心电图异常≥2次是患者出院时预后不良的独立危险因素(P <0. 05)。结论老年急性CIS患者普遍存在心电图异常,≥2次检出心电图异常可能预示患者预后较差,临床重视心电图变化对评估CIS预后有一定参考价值,有助于指导制定治疗方案。
Objective To investigate the changes of electrocardiogram in elderly patients with acute cerebral ischemic infarction( CIS),and to analyze the relationship between the electrocardiogram and the prognosis of the patients. Methods 132 elderly patients with acute CIS in the hospital from January2013 to December 2016 were enrolled. 12 lead electrocardiogram was performed within 48 hours after onset and 7 days after onset,and the relationship between electrocardiogram abnormality and infarct type,severity,and prognosis were analyzed. The independent predictors of poor prognosis based on improved Rankin's score at discharge were evaluated. Results 83 cases( 62. 88%) had abnormal electrocardiogram. The main type of abnormal electrocardiogram was S-T segment abnormalities,followed by arrhythmia. The severity of illness in patients with abnormal electrocardiogram were significantly more serious than in those who did not detect abnormal electrocardiogram( P < 0. 05). The severity of illness in patients detected abnormal electrocardiogram over 2 times were significantly more serious than in those who detected abnormal electrocardiogram only within 48 hours after onset or 7 days after onset( P < 0. 05). Shorter time from onset to admission,complete anterior circulation infarction according to Oxfordshire Community Stroke Project( OCSP)classification,abnormal electrocardiogram( > 2 times) were independent risk factors for poor prognosis at discharge( P < 0. 05). Conclusions Electrocardiogram abnormity is common in elderly patients with CIS,and abnormal electrocardiogram detected over 2 times may indicate poor prognosis,which will benefit for the treatment schemes of patients.
Objective To investigate the changes of electrocardiogram in elderly patients with acute cerebral ischemic infarction( CIS),and to analyze the relationship between the electrocardiogram and the prognosis of the patients. Methods 132 elderly patients with acute CIS in the hospital from January2013 to December 2016 were enrolled. 12 lead electrocardiogram was performed within 48 hours after onset and 7 days after onset,and the relationship between electrocardiogram abnormality and infarct type,severity,and prognosis were analyzed. The independent predictors of poor prognosis based on improved Rankin's score at discharge were evaluated. Results 83 cases( 62. 88%) had abnormal electrocardiogram. The main type of abnormal electrocardiogram was S-T segment abnormalities,followed by arrhythmia. The severity of illness in patients with abnormal electrocardiogram were significantly more serious than in those who did not detect abnormal electrocardiogram( P < 0. 05). The severity of illness in patients detected abnormal electrocardiogram over 2 times were significantly more serious than in those who detected abnormal electrocardiogram only within 48 hours after onset or 7 days after onset( P < 0. 05). Shorter time from onset to admission,complete anterior circulation infarction according to Oxfordshire Community Stroke Project( OCSP)classification,abnormal electrocardiogram( > 2 times) were independent risk factors for poor prognosis at discharge( P < 0. 05). Conclusions Electrocardiogram abnormity is common in elderly patients with CIS,and abnormal electrocardiogram detected over 2 times may indicate poor prognosis,which will benefit for the treatment schemes of patients.
引文
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[2]高连波,于长江,高红华,等.急性脑梗死合并心脏病对患者短期预后的影响[J].中国全科医学,2014,17(9):980-983,988. DOI:10. 3969/j. issn. 1007-9572. 2014. 09. 002.
[3]Payabvash S,Benson JC,Tyan AE,et al. Multivariate Prognostic Model of Acute Stroke Combining Admission Infarct Location and Symptom Severity:A Proof-of-Concept Study[J]. J Stroke Cerebrovasc Dis,2018,27(4):936-944. DOI:10. 1016/j. jstrokecerebrovasdis. 2017. 10. 034.
[4]齐洁,高红梅,龙涛,等.急性脑梗死合并脑心综合征患者血糖水平对预后的影响[J].中华危重病急救医学,2016,28(7):646-647. DOI:10. 3760/cma. j. issn. 2095-4352. 2016. 07. 016.
[5]刘忠志,王普清.影响短暂性脑缺血发作发展至急性脑梗死的危险因素分析[J].医学综述,2015,21(21):3980-3981.DOI:10. 3969/j. issn. 1006-2084. 2015. 21. 048.
[6]中华医学会神经病学分会,中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2014[J].中华神经科杂志,2015,48(4):246-257. DOI:10. 3760/cma. j. issn.1006-7876. 2015. 04. 002.
[7]Sung SF,Wu CS,Hsu YC,et al. Oxfordshire Community Stroke Project classification but not NIHSS predicts symptomatic intracerebral hemorrhage following thrombolysis[J]. J Neurol Sci,2013,324(1-2):65-69. DOI:10. 1016/j. jns. 2012. 10. 003.
[8]Tan WS,Sexton S,Mulcahy R. National Institutes of Health Stroke Scale(NIHSS):Are Hospital Doctors Up To Date?[J].Ir Med J,2015,108(8):253-254.
[9]范玉华,姬晓昙,蓝琳芳.国内脑卒中临床试验疗效判断方法中改良Rankin评分的应用现状[J].中国神经精神疾病杂志,2015,41(7):412-415. DOI:10. 3969/j. issn. 1002-0152.2015. 07. 006.
[10]李乐燕,王建国,马勇.老年急性脑梗死患者心电图和心肌标志物变化与预后的关系[J].心血管康复医学杂志,2014,23(3):262-264,265. DOI:10. 3969/j. issn. 1008-0074. 2014. 03. 08.
[11]李黎,童佳,何淼,等.老年急性缺血性脑血管病患者心电图与超声心动图异常的对比研究[J].中国临床保健杂志,2017,20(1):19-21. DOI:10. 3969/J. issn. 1672-6790. 2017. 01. 007.
[12]张允,陆学胜,张燕,等.缺血性脑卒中急性期血清肌钙蛋白Ⅰ升高的临床意义[J].实用临床医药杂志,2015,19(21):9-12. DOI:10. 7619/jcmp. 201521003.
[13]Siegerink B,Maino A,Algra A,et al. Hypercoagulability and the risk of myocardial infarction and ischemic stroke in young women[J]. J Thromb Haemost,2015,13(9):1568-1575. DOI:10.1111/jth. 13045.
[14]赵伟.急性缺血性脑卒中并心房颤动患者静脉溶栓治疗后出血转化的危险因素研究[J].实用心脑肺血管病杂志,2015,23(12):12-15. DOI:10. 3969/j. issn. 1008-5971. 2015. 12. 004.
[15]孟素芳,高健.急性脑梗死患者心电图缺血性ST-T改变与预后的关系[J].中国实用神经疾病杂志,2016,19(11):101-102. DOI:10. 3969/j. issn. 1673-5110. 2016. 11. 059.
[16]Lasek-Bal A,Kowalewska-Twardela T,Gsior Z,et al. The significance of troponin elevation for the clinical course and outcome of first-ever ischaemic stroke[J]. Cerebrovasc Dis,2014,38(3):212-218. DOI:10. 1159/000365839.
[17]李雯,徐晓霞,刘学东.青中年缺血性脑卒中患者预后及其影响因素研究[J].中西医结合心脑血管病杂志,2014,12(1):51-52. DOI:10. 3969/j. issn. 1672-1349. 2014. 01. 0029.