脑栓塞合并心房顿抑的预后及其抗凝治疗

Prognosis and anticoagulant therapy observation in patients with cerebral embolism complicated by atrial stunning real fibrillation

目的分析脑栓塞合并心房顿抑患者占房颤发生脑栓塞患者的百分率及其预后,探索其抗凝治疗方案,以达到改善预后及减少复发。方法选择急性脑栓塞同时合并心房顿抑患者80例,随机分为两组,治疗组42例,对照组38例。两组一般情况差异无统计学意义。治疗组患者在控制脑水肿,改善循环,促进脑代谢等常规治疗的同时,给予华法林2.5 mg/d,至少4周,然后继续服用24个月。治疗过程中检测凝血系列项目。对照组仅常规治疗同治疗组,不服用华法林,口服阿司匹林100 mg/d。比较两组患者4周后的病死率,致残率及随访24个月的复发率。结果治疗组在治疗4周后,病死率、致残率明显低于对照组,差异均有统计学意义(P<0.01);4周后NIHSS评分、BI评分比较治疗组有明显改善(P<0.05),治疗组患者复发率明显小于对照组,二者差异有统计学意义。结论华法林抗凝治疗房颤疗效显著,虽然存在出血并发症,但在密切监测下应用仍比较安全,值得普及和推广。

Objective To study the percentage of cerebral embolism complicated by atrial stunning real fibrillation in patients with cerebral embolism,analyze the prognosis and anticoagulation regimens,to improve the prognosis and reduce the recurrence.Methods Patients with acute cerebral embolism and atrial stunning numbered 42,control group 38. The two groups had no significant difference in age. Patients in the treatment group were treated by controlling cerebral edema,improving circulation,promoting brain metabolism and other conventional treatment at the same time; warfarin 2. 5 mg,QD,was given for at least 4 weeks,Then continued for 24 month. During the treatment,coagulation series was detected. The control group was only treated with routine as in treatment group,with out taking warfarin,but aspirin 100 mg was given. After 4 weeks,mortality,morbidity and relapse rates after followed-up for 24 months compared between the two groups of patients. Results In the treatment group,4 weeks after treatment,the fatality rate and mutilation rate were significantly lower than those in the control group,with significant difference（ P〈0. 01）; after 4 weeks,BI NIHSS score in the treatment groups improved significantly（ P〈0. 05）,and relapse rate was significantly less than in the control group. Conclusions Warfarin therapy in the treatment of patients with atrial fibrillation has a significant effect,although there is complication of bleeding,but under close monitoring it is still relatively safe,worthy of popularization in clinical practice.