高龄老年非瓣膜性心房颤动合并急性缺血性卒中患者临床特点分析

Analysis of clinical characteristics of non-valve atrial fibrillation and acute ischemic stroke in the very elderly patients

目的分析非高龄老年非瓣膜性心房颤动（NVAF）合并急性缺血性卒中（AIS）患者的临床特点。方法选取在我院神经内科住院的≥60岁老年NVAF合并AIS患者105例，根据年龄分为高龄老年组（≥80岁）44例和非高龄老年组（60～79岁）61例。对患者一般资料及临床资料进行回顾性分析，探讨高龄老年NVAF合并AIS的危险因素、AIS类型、AIS并发症及预后等特点。结果与非高龄老年患者比较，年龄是高龄老年NVAF合并AIS的危险因素。高龄老年患者AIS病情重，入院时美国国立卫生研究院卒中量表评分（NIHSS评分）（11.59±7.76）分，高于非高龄老年组（6.03±7.12）分（t＝3.80，P＝0.000），发病1个月后高龄老年组的预后较差，改良Rankin量表（mRS）评分≥3分的比例为56.8%（25例），高于非高龄老年组（21.3%、13例）（χ2＝13.96，P〈0.01）。与非高龄老年组比较，高龄老年组患者AIS类型以大脑前循环梗死为主（χ2＝12.28，P＝0.020）。与非高龄老年人17例（27.9%）、8例（13.1%）、7例（11.5%）比较，高龄老年组患者AIS后肺部感染29例（65.9%）、胃肠道出血16例（36.4%）、急性冠状动脉综合征或心功能不全15例（34.1%）发生率高（χ2＝14.53、7.84、7.89，均P〈0.05）。结论年龄是高龄老年NVAF合并AIS患者主要危险因素，高龄老年患者AIS病变部位多累及大脑前循环系统，高龄老年NVAF患者发生AIS的病情重，易出现并发症，临床预后差。

ObjectiveTo compare the clinical characteristics of patients with non-valve atrial fibrillation（NAVF）and acute ischemic stroke（AIS）between two groups： aged ≥80 years versus 60-79 years.MethodsOne hundred and five inpatients with NVAF and AIS, treated in Neurological Department Beijing Hospital from November 2009 to November 2014, were divided into two groups of the very elderly patients（≥80 years, n=44）and old patients（60-79 years, n=61）. Baseline data and clinical characteristics of patients with NAVF and AIS were retrospectively compared between the two groups to explore their risk factors, subtypes of AIS, the complications and prognosis.ResultsAge was the risk factor for stroke in the very elderly patients with NAVF.Compared with old patients group, the very elderly patients were associated with significantly higher baseline NIHSS（National Institutes of Health Stroke Scale）（11.59±7.76 vs. 6.03±7.12, t=3.80, P=0.000）. The rates of mRS（modified Rankin Scale）≥3（poorer clinical turnover）1 or more month after AIS was 21.3% in the old patients versus 56.8% in the very elderly patients（χ2=13.96, P〈0.01）. Moreover, anterior circulation infarction was the main subtypes of AIS in the very elderly patients versus old patients（χ2=12.28, P=0.020）. Meanwhile, the very elderly patients versus the old patients had markedly higher rates of complications of AIS, such as pneumonia（65.9% vs. 27.9%; χ2=14.53, P〈0.05）, gastrointestinal bleeding（36.4% vs. 13.1%; χ2=7.84, P〈0.05）, acute coronary syndrome or heart failure（34.1% vs.11.5%; χ2=7.89, P〈0.05）.ConclusionsThe very elderly patients versus the old patients show that risk factors for NVAF with AIS are more often the ageing and smoking, and that anterior cerebral circulation is more often affected.The degrees of NVAF and AIS severity are higher, the more complications are found, and the prognosis is worse.