446例急性缺血性脑卒中患者早期持续心电图异常对预后不利影响的多中心前瞻性研究

Adverse Effect of Early Continuous ECG Abnormality on Its Prognosis in Patients with Acute Ischemic Stroke——A Prospective Multicenter Study of 446 Patients in Two Cities

目的本研究旨在探寻急性缺血性脑卒中患者心电图异常的发生时间与患者不良预后的关系,并分析心电图异常的主要表现方式。方法分别在上海市和武汉市的23家医院神经内科住院患者中,入选发病48 h内的急性脑梗死患者446例。于发病48 h内和第7天分别进行常规12导联心电图检查,以改良Rankin’s评分作为评价指标在出院时与发病第90天对患者的预后进行随访。结果①完全前循环梗死以及持续心电图异常为急性缺血性脑卒中患者近期及发病90d预后不良的独立预测因子。②急性脑梗死患者中有70.1%的患者存在至少1次心电图异常;在发病48 h内和第7天的心电图检查中有45.9%的患者均存在异常。③心电图异常以心肌缺血样改变最为常见,其次为心律失常;心脏功能单表现为T波改变对急性缺血性脑卒中的预后没有评价意义。结论急性缺血性脑卒中发病早期易出现心脏缺血性损伤,偶发单次的心电图异常对预后无明显影响;发病48 h内即开始出现心电图异常并持续1周以上对预后有独立预测价值,其发生预后不良的概率是心电图正常患者的2倍以上。

Aim To explore the relationship between occurrence time of electrocardiogram （ECG） abnormality in patients with acute ischemic stroke and its prognosis, and analyze the manifestation modes of electrocardiogram abnormality. Methods 446 inpatients suffered from acute ischemic stroke within 48 hours from the department of neurology of 23 hospitals in Shanghai and Wuhan were studied. All patients were examined by conventional 12 lead ECG in the first 48 hours after onset symptom, and reexamined at day 7. They were followed up in the first day and 90 days after discharged with Modified Rankin＇ s Score as evaluation index. Results （1） The total abterior circulation infarct （TACI） in OCSP （Oxfordshire Community Stroke Project） and continuous ECG abnormality would be an independent predictor of adverse outcome in the recent and after 90 days for acute ischemic stroke patients. In patients with acute cerebral infarction, 70.1% had at least one-time EC ischemia was the most common ECG abnormality, the second was arrhythmia. Singly T wave changes had no significance for valuating prognosis in patients with acute ischemic stroke. Conelusion Patients with acute ischemic stroke are more likely to have heart ischemic injury in early stage. But only the continuous ECG abnormalities lasting until 7 days later has independent predictive value. The occurrence probability of adverse prognosis in patients with abnormal ECG may be one time more than the patient with normal ECG.