单纯短暂失语结合CHADS2评分快速鉴别心源性短暂缺血发作

Rapid identification of cardioembolic TIA via emergency isolated transient aphasia and CHADS2 score

目的将急诊患者的短暂单纯性失语表现结合CHADS2评分,以评价其是否可以作为快速鉴别心源性短暂缺血发作(transient ischemic attack,TIA)的手段。方法前瞻性分析2010年10月至2014年4月期间538例在我院确诊且在急诊室仍有神经损害表现的TIA患者。潜在心源性栓子定义为有房颤史,心电图、长程心电监测或超声心动图证实,以及在心超中发现栓子。入组患者分为短暂单纯失语组(A组)和其他神经损害组(B组),结合CHADS2评分,使用PASW软件分析数据。结果 538例TIA患者中,25例表现为短暂单纯失语(A组)。这些患者年龄更大[(72.9±9.0)岁vs.(65.2±10.5)岁,P=0.004],有心力衰竭病史的比例更高(8.6%vs.2.0%,P=0.025),具有心源性栓子的可能性是B组的2倍(22.9%vs.9.0%,P=0.027)。CHADS2分值与心源性栓子存在呈正相关。结论 TIA发作后,短暂单纯性失语且CHADS2评分较高的患者需要接受快速全面的心源性因素评估。

Objective To make clear that whether isolated transient aphasia and CHADS2 score could rapidly identify cardioembolie transient ischemic attack （TIA）in emergency cases. Methods We prospectively studied a cohort of 538 c.ases of final emergency department diagnosis of TIA between Oct. ,2010 and Apr. ,2014 in our hospital. Patients with transient isolated aphasia were identified by the treating physician at the time of emergency department presentation. Potential cardiae sources for embolism were defined as atrial fibrillation on history, electrocardiogram, Holter monitor, atrial fibrillation on echocardiography, or thrombus on echocardiography. Patients were divided into 2 groups： isolated aphasia group （A group） and all other defidts group （B group）. CHADS2 score was introduced and Predictive Analytics Software （PASW） he data. Results Of the 538 TIA patients, 25 cases had transient isolated aphasia as their only neurological deficit （A group）. Compared with B group, these patients were older [（72. 9 ± 9. 0） years vs. （65,2 ± 10.5） years,P = 0.004）], more likely to have a history of heart failure （8.6% vs. 2. 0%, P= 0.025）, and were twice as likely tohave cardiac embolism （22.9% vs. 9.0%, P=0.025）. CHADS2 score had positive relationship with cardiac-embolism. Couelusions Patients with transient isolated aphasia and high CHADS2 score need a rapid and thorough assessment for a eardio-embolism.