急性脑梗死脑心综合征发生的时间规律及其持续时间与临床预后的关系

Relation of brain-heart syndrome occurring time with its duration and clinical outcome in acute ischemic stroke patients

目的明确急性脑梗死后脑心综合征（BHS）发生的时间规律及其持续时间与脑梗死临床预后的关系。方法回顾研究发病24h内经影像学检查证实为急性脑梗死的患者86例,将发生BHS 62例作为BHS组。又将BHS组以BHS持续时间分为〈7d组31例和≥7d组31例。另将未发生BHS的24例作为无BHS组。收集患者脑梗死发病后第1、2、3~5、6~8、9~11、12~14天心电图、肌酸激酶和肌酸激酶同工酶、B型钠尿肽、心肌肌钙蛋白T、心脏超声、LVEF;入院及住院14d时美国国立卫生研究院卒中量表（NIHSS）评分、改良的Rankin量表（mRS）评分。采用Kaplan-Meier生存曲线分析BHS持续时间对预后的影响。结果 BHS组患者出现心肌酶、心电图、超声心动图任意1种异常的时间为（22.7±17.4）h,BHS发生高峰在脑梗死后12~24h。BHS持续时间为（8.2±3.6）d,中位时间为7d。BHS组NIHSS评分（12.8±3.9）分,无BHS组为（7.8±3.1）分,2组比较有显著差异（P=0.04）。〈7d组住院时间较≥7d组缩短（P=0.03）,〈7d组出院时NIHSS和mRS评分低于≥7d组（χ2=23.3,Plog rank〈0.01;χ2=34.4,Plog rank〈0.01）。结论对可能继发BHS的急性脑梗死发病后心脏监护应≥48h,对患者及时药物和非药物干预,有可能缩短BHS的持续时间,可能改善脑梗死的临床预后。

Objective To study the relation of brain-heart syndrome（BHS）occurring time with its duration and clinical outcome in AIS patients.Methods Eighty-six AIS patients diagnosed by CT/MRI/CTA/DSA within 24 hafter admission were divided into BHS group（n=62）and BHSfree group（n=24）.The patients in BHS group were further divided into 〈7dBHS group（n=31）and≥7d group（n=31）.The patients underwent ECG and echocardiogram.Their serum CK,CK-MB,BNP,cTnT levels and LVEF were measured on days 1,2,3-5,6-8,9-11 and 12-14 respectively after admission.The effect of BHS duration on the clinical outcome of AIS patients was analyzed according to the Kaplan-Meier Survival Curve.Results The mean time of any abnormal finding on ECG and echocardiogram was 22.7±17.4hin BHS group.BHS reached its peak at 12-24 hafter ischemic stroke and then decreased gradually.The duration of BHS was8.2±3.6dand its median time was 7d.The NIHSS score was significantly higher in BHS group than in BHS-free group（12.8±3.9 vs 7.8±3.1,P=0.04）.The hospital stay time was shorter in7dBHS group than in≥7dBHS group（P〈0.05）.The NIHSS and mRS scores were lower in7d BHS group than in ≥7dBHS group at discharge（P〈0.01）.Conclusion Cardiac monitoring time should be≥48hin AIS patients secondary to BHS.Medication or non-medication intervention can shorten the duration of BHS and improve the clinical outcome of AIS.