心房颤动对急性缺血性脑卒中溶栓治疗预后影响的研究

Study on influence of atrial fibrillation on prognosis of acute ischemic stroke treated with thrombolytic therapy

目的:探讨心房颤动(AF)对急性缺血性脑卒中(AIS)患者接受重组组织型纤溶酶原激活物(rtPA)溶栓治疗预后的影响。方法:2010年6月至2012年9月在我院急诊科收治的符合2010年全国脑血管学术会议制定诊断标准的AIS患者,按照心电图是否有AF表现分为AF组、非AF组2组。均按照《中国脑血管病防治指南》的标准进行溶栓及溶栓后治疗,记录患者就诊即刻、溶栓后24 h的美国国立卫生研究院卒中量表(NIHSS)评分,并电话随访患者3个月的改良Rankin量表(mRS)评分、自发性颅内出血(sICH)及死亡情况。结果:共114例患者入选,2组患者年龄及男女比例存在统计学差异(均P<0.05)。入院即刻AF患者NIHSS评分为(11.0±7.5)分,非AF组为(7.0±6.0)分,2组比较差异具有统计学意义(P=0.004),溶栓后24 h NIHSS评分2组间无差异(P=0.123)。sICH的发生率AF组为43.3%,而非AF组为17.9%(P=0.005)。3个月后的mRS评分及死亡情况2组间无明显差异(均P>0.05)。结论:AF合并AIS的患者经过rtPA溶栓治疗,溶栓后24 h及3个月均未获得比非AF患者更好的神经功能恢复,而sICH的发生率却显著增加。因此建议急诊医师在AF合并AIS患者的溶栓治疗选择上应慎重。

Objective To investigate the influence of atrial fibrillation （AF） on prognosis of acute ischemic stroke （AIS） treated with recombinant tissue plasminogen activator （rtPA） thrombolytic therapy. Methods All of the AIS patients diagnosed in accordance with the Chinese guideline on the prevention and treatment of cerebrovascular disease and admitted from June, 2010 to September, 2012 were enrolled. Patients were divided into two groups according to the electrocardiogram whether there was auricular fibrillation（AF） or not （group AF, group non-AF ）. All patients were treated with rtPA and other neuroproteetants recommended by the guideline. The National Institute of Health stroke scale （NIHSS） score on the acute attack, NIHSS score 24 h after thrombolysis, and modified Rankin scale （mRS） score, morbidity of symptomatic intracerebral hemorrhage （sICH） and mortality within three months were recorded. Results One hundred and fourteen patients were enrolled. There were statistically significant differences between patients with and without AF on age and sex ratio （all P〈O.05）. The NIHSS immediately on hospitalization for patients with AF was 11.0±7.5, while that for patients without AF was 7.0±6.0 （P=0.004）. However, no significant differences in NIHSS was seen 24 h after thrombolysis （P=0.123） . The morbidity of sICH in patients with AF was 43.3%, while that without AF was 17.9% （P=0.005）. No significant differences were found in mRS score and 3-month mortality between the two groups. Conclusions The recovery of neurological function 24 h after rtPA thrombolytic therapy and three months later in AIS patients with AF was similar to that without AF. However, the morbidity of sICH was significantly higher. The emergency physician needs to take judicious consideration for the use of thrombolytic therapy in patients of AIS with AF.