不同部位脑卒中患者心脏自主神经活性与心脏损害

Abnormal eletrocardiogram, plasma CK-MB level and heart rate variabilityin patients with acute hemispheric cerebral stroke

目的 :了解不同部位脑卒中对心脏自主神经活性和心脏的影响。方法 :检测 389例不同部位大脑半球梗死和出血急性期患者及 2 0 6例对照的心率变异性 (HRV)、标准十二导联心电图 (ECG)和血浆肌酸激酶同工酶CK -MB活性 ,分析其HRV、ECG复极改变、心律失常和CK -MB活性变化的关系。结果 :右侧岛叶和其邻近部位脑卒中患者急性期室上性快速心律失常和QTc明显延长发生率显著增高 ;左侧岛叶和其邻近部位脑卒中患者急性期心电图ST段压低发生率显著增高 ;CK -MB活性升高主要见于岛叶和其邻近部位脑卒中患者 ,双侧无显著性差异。右侧岛叶和其邻近部位脑卒中患者心率变异性指标HF、RMSSD、PNN5 0显著下降和LF/HF显著增高。伴室上性快速心律失常者LF和LF/HF高于无室上性快速心律失常者 ,HF显著低于无室上性快速心律失常者。结论 :大脑半球卒中患者对心脏的影响主要与岛叶或其邻近部位病变有关 ,对这些患者应加强心电监护、心肌酶谱检查和心脏保护。

Objective:To assess the effect of localization of cerebral stroke on cardiac damages and cardiac autonomic nervous activity.Methods:ECG,plasma CK-MB level and heart rate variability(HRV) recordings were measured and analysed among 389 patients with hemispheric cerebral stroke in the acute phase and among 206 control subjects.Results:Supraventricular arrhythmias and prolonged QTc were significantly increased in groups of right insular infarction,fight putamental and frontoparietotemporal hemorrhage as compared with groups of stroke in other regions.A significantly increased rates of ST segment abnormalities were found in groups of left insular infarction,left putamental and frontoparietotemporal hemorrhage as compared with groups of stroke in other regions.Plasma CK-MB level increase was only found in insular infarction,and similarity was seen between the right and left.The measured components of HRV,ie,HF,RMSSD,and PNN50 were significantly lower,and LF/HF were significantly higher in groups of right insular infarction,right putamental and frontoparietotemporal hemorrhage in acute phase compared with groups of stroke in other regions and control group.Conclusion:The effects of hemispheric stroke on heart function and cardiac autonomic nervous activity are mainly correlated with destruction of insular or regions adjacent to the insular.