心脏手术后心源性卒中预防的研究进展

Research progress in prevention of cardiogenic stroke prevention after cardiac surgery

缺血性卒中患者中有20%~30%是心源性卒中。房颤形成的血栓是心源性卒中的主要风险,房颤会使卒中发生率增加5倍。房颤产生血栓的部位主要在左心耳,这与后者特殊的解剖结构有关。除了采用传统抗栓药物预防血栓形成,采用左心耳干预来预防心源性卒中也是当前的研究热点。预防术后房颤尤为重要,其中钙介导神经毒性抑制心房自主神经节、左后心包切开术预防心脏手术后房颤效果显著。此外,microRNA与房颤的关系也越来越被重视。该文针对心源性卒中的预防,从减少房颤发生与避免血栓形成进行了综述。

20% to 30% of ischemic stroke patients have a cardiogenic stroke.Thrombosis caused by atrial fibrillation is the major risk for cardiac stroke, and atrial fibrillation increasing the incidence of stroke by five times.The site of thrombus in atrial fibrillation is mainly in the left atrial appendage, which is related to the special anatomical structure of the left atrial appendage.In addition to the use of traditional antithrombotic drugs to prevent thrombosis, the use of left atrial appendage intervention to prevent cardioembolic stroke is also a current research focus.Prevention of postoperative atrial fibrillation is particularly important, among which calcium-mediated neurotoxic inhibition of atrial autonomic ganglion and left posterior pericardiotomy are effective in preventing postoperative atrial fibrillation.In addition, the relationship between microRNA and atrial fibrillation has been paid more and more attention.Aiming at the prevention of cardiogenic stroke, the authors reviewed the researches of the prevention of cardioembolic stroke from the aspect of reducing the occurrence of atrial fibrillation and avoiding thrombosis.