脑干出血并发脑心综合征心律失常与儿茶酚胺浓度的临床分析

Clinical analysis of cerebral stem hemorrhage complicated with arrhythmia and catecholamine concentration in patients with cerebrocardiac syndrome

目的探讨脑干出血合并脑心综合征（CCS）患者心律失常与儿茶酚胺（Cate-cholamine,CA）浓度的相关性。方法选取2013年2月-2016年2月该院脑干出血患者92例（脑干出血组）,脑干出血并发CCS心律失常患者70例（CCS组）以及2015年9月-2016年2月该院健康体检者30例（对照组）。于发病后24 h和5 d分别检测儿茶酚胺[去甲肾上腺素（NE）、肾上腺素（E）、多巴胺（DA）]浓度,记录同步心电图。结果 70例脑干出血并发CCS心律失常患者中快速型心律失常46例（65.71%）,缓慢型心律失常24例（34.28%）。CCS组死亡率高于脑干出血组,差异有统计学意义（χ^2=5.271,P=0.020）。CCS组发病24 h NE、E、DA浓度高于脑干出血组,两组NE、E、DA浓度高于对照组,差异有统计学意义（P〈0.05）。发病5 d后,CCS组NE、E、DA浓度仍高于脑干出血组,两组均高于对照组,差异均有统计学意义（P〈0.05）。快速心律失常患者发病24 h和5 d的NE、E、DA浓度比较,均高于缓慢心律失常患者,差异有统计学意义（P〈0.05）。相关性分析示,脑干出血并发CCS心律失常患者CA浓度（NE、E、DA）与快速型心律失常的发生呈正相关,与缓慢型心律失常的发生无相关,与预后呈正相关。随着脑干出血并发CCS患者CA浓度升高,快速型心律失常的发生率越高,死亡率越高。结论脑干出血并发CCS心律失常患者的CA浓度与心律失常的发生有相关性,可以早期评估病情及预后。

Objective To study the correlation between arrhythmia occurrence in patients with brain stem hemorrhage complicated with cerebrocardiac syndrome（CCS） and blood catecholamine（CA）. Methods This study collected 92 cases of brain stem hemorrhage and 70 cases of brain stem hemorrhage complicated with CCS arrhythmia treated in our hospital from Feb. 2013 to Feb. 2016 and 30 people having health examination in our hospital between Sep. 2015 and Feb. 2016 as control group. At 24 hours and 5 days after onset,the levels of catecholamine norepinephrine（NE）, adrenaline（epinephrine, E） and dopamine（DA） were detected, and synchronous ECG was recorded. Results Among the 70 patients of brain stem hemorrhage complicated with CCS arrhythmia, there were 46 cases of rapid arrhythmia（65.71%） and 24 cases of slow arrhythmia（34.28%）. The mortality of the CCS group was higher than that in the brain stem hemorrhage group, the difference was statistically significant（χ^2= 5.271 P = 0.020）. At 24 h after onset, NE, E and DA concentrations in the CCS group were significantly higher than those in the brain stem hemorrhage group; NE, E and DA concentrations in the two groups were significantly higher than those in the normal control group（P〈0.05）.On the 5th day after onset, NE, E and DA concentrations in the CCS group were still higher than those in the brain stem hemorrhage group; NE, E and DA concentrations in the two groups were significantly higher than those in the normal control group（P〈0.05）. NE, E and DA concentrations of the patients with rapid arrhythmia were significantly higher than those of the patients with slow arrhythmia 24 h and 5 d after onset（P〈0.05）. Correlation analysis showed that the concentration of CA（NE, E, DA） in the patients with brain stem hemorrhage complicated with CCS arrhythmia was positively associated with the occurrence of rapid arrhythmia. The higher the CA concentration in the patients with brain stem hemorrhage, the higher the incidence of rapid arrhythmia, the higher the mortality rate. Conclusions There is a certain correlation between CA concentration and occurrence of arrhythmia in patients with brain stem hemorrhage complicated by CCS.CA concentration could be an early assessment of the disease severity and prognosis.