急性出血性脑血管病心电图改变的临床分析

Acute hemorrhagic cerebrovascular disease electrocardiogram changes of clinical analysis

目的探讨急性出血性脑血管病的心电图异常改变，分析临床价值。方法回顾性分析了2010年至2012年来我院神经外科住院的197例急性出血性脑血管病患者的心电图改变，患者经颅脑CT或磁共振成像（MRI）检查证实急性缺血性脑血管病，并于发病的0．5—1天内做常规床旁心电图检查，其中有128例患者在1～3周内进行2～4次心电图复查，结合相关文献对其临床意义进行分析。结果共检出异常心电图128例，总异常率达65．1％，心电图异常表现主要包括复极异常、节律异常、传导异常、房室异常，其中又以复极异常中的ST—T改变在心电图异常者中所占比例最高，占47．7％，其次是心律失常，占25．0％。脑干出血组心电图异常率最高（83．3％），蛛网膜下腔出血组次之（80．6％），小脑出血组最低（22．2％），不同出血组比较差异有统计学意义（P〈0．05）。结论心电图异常发生与出血性脑血管病的特定部位，自主神经功能紊乱，水、电解质失衡及脑、心血管病变存在共同病理基础因素有关，对于各种心脏异常的发生，临床医师应根据心电图检查所见，给与足够的重视，对判断病情及预后有重要临床价值。

Objectives To analyze electrocardiogram （ECG） abnormal changes in acute hemorrhagic cerebrovascular diseases and discuss the clinical significance. Methods We retrospective analyzed the ECG changes of 197 acute cerebral hemorrhagic patients from 2010 to 2012 in our hospital neurosurgery. All cerebral hemorrhage was confirmed by head CT or MRI and routine bedside ECG in the incidence of 0.5 to 1 day and reexamined 2 to 4 times during 1 to 3 weeks. Results One hundred twenty eight cases with abnormal ECG were detected, and the total abnormal rate was 65.1%. The abnormal ECG mainly included abnormal repolarization, dysrhythmias, abnormal atrioventricular conduction. The incidences of ST-T changes in abnormal repolarization and arrhythmia were respectively 47.7% and 25.0%. The rates of abnormal ECGs in hemorrhage of brainstem, subarachnoid space and parencephalon were 83.3%, 80.6% and 22.2%. There were significant differences among three groups （P 〈 0.05）. Conclusion ECC abnormalities were related with specific cerebral hemorrhagic positions, dysfunction of the autonomic nervous system, water and electrolyte imbalance and common pathological basis factors of cerebral and cardiovascular diseases. Clinicians should check the ECG and pay enough attention for the occurrence of various cardiac abnormalities.