心房颤动对不同治疗时机下脑梗死患者静脉溶栓效果影响的研究

Influence of atrial fibrmafion on intravenous thrombolysis of acute ischemic stroke patients within different time window

目的探讨心房颤动对不同治疗时机下脑梗死患者静脉溶栓效果的影响,为其临床研究提供可参考依据。方法共纳入100例确诊为发病时间6 h内的急性脑梗死患者作为研究对象,在知情同意原则下,根据发病时间分析≤3 h组与3-6 h组,并根据是否合并有心房颤动分为房颤组与非房颤组,所有患者均给予尿激酶静脉溶栓治疗。随访3个月比较两组患者疗效。结果 100例急性脑梗死患者中,44例（44.0%）患者发病≤3h,其中心房颤动患者15例,非心房颤动患者29例;56例（56.0%）患者发病3-6 h,其中心房颤动患者20例,非心房颤动患者36例。房颤对不同溶栓时机相同时间段患者神经功能的恢复无明显影响（P〉0.05）。3-6 h组房颤组患者溶栓后24 h内发生PH出血的比例明显高于非房颤组患者,差异有统计学意义（P〈0.05）。随访3个月后发现,房颤对不同溶栓时机患者mRS评分无明显影响（P〉0.05）。结论心房颤动对不同溶栓时机患者的疗效及神经功能恢复无影响,但增加了时间窗为3-6 h的脑梗死患者PH出血的风险。

Objective To assess the influence of atrial fibrillation on post-thrombolytic hemorrhagic transformation and functional prognosis in acute ischemic stroke patients within different time window. Methods 100 patients with acute posterior-circulation ischemic stroke（onset time within 6h） were included. All patients were divided into ≤ 3h group and 3-6 h group according to the onset time. All patients were also divided into atrial fibrillation group and non-atrial fibrillation group according to whether having atrial fibrillation. All patients were given urokinase intravenous thrombolysis treatment. The curative effect were compared followed up for 3 months. Results There were 44（44.0%） patients with onset time within 3h,in which 15 patients with atrial fibrillation and 29 patients without atrial fibrillation. There were 56（56.0%） patients with onset time 3-6 h,in which 20 patients with atrial fibrillation and 36 patients without atrial fibrillation. There were no effects of atrial fibrillation for the recovery of neural function（P〉0.05）. The rate of PH bleeding occurred in patients with atrial fibrillation in 3-6 h group within 24h was higher than that in patients without atrial fibrillation. The difference was statistically significant（P〈0.05）. Followed up for3 months,we found that There were no effects of atrial fibrillation for the m RS score（P〉0.05）. Conclusions The presence of atrial fibrillation is not associated with the prognosis in thrombolytic patients. However,it enhanced the risk of parenchymal hematoma if patients were treated within the time window 3-6 h.