中华神经科杂志
中華神經科雜誌
중화신경과잡지
Chinese Journal of Neurology
2015年
8期
661-667
,共7页
娄一萍%张圣%严慎强%万锦平%楼敏
婁一萍%張聖%嚴慎彊%萬錦平%樓敏
루일평%장골%엄신강%만금평%루민
心房颤动%脑缺血%卒中%血栓溶解疗法%组织型纤溶酶原激活物%时间%预后
心房顫動%腦缺血%卒中%血栓溶解療法%組織型纖溶酶原激活物%時間%預後
심방전동%뇌결혈%졸중%혈전용해요법%조직형섬용매원격활물%시간%예후
Atrial fibrillation%Brain ischemia%Stroke%Thrombolytic therapy%Tissue plasminogen activator%Time%Prognosis
目的 分析不同发病-溶栓时间窗内,合并心房颤动对急性缺血性脑卒中患者静脉溶栓治疗后出血转化和预后的影响.方法 回顾性分析2009年6月至2013年10月本科接受静脉重组组织型纤溶酶原激活剂(rt-PA)溶栓治疗的急性缺血性脑卒中患者的资料,根据时间窗分为3组[≤3.0 h(A)、＞3.0h且≤4.5 h(B)和＞4.5 h(C)组,通过多因素分析3组患者心房颤动对溶栓后出血性梗死(HI)、脑实质出血(PH)及良好神经功能结局[改良Rankin量表评分(mRS)评分≤2分]的影响.结果 共345例患者纳入研究,其中A组101例(29.3％),B组157例(45.5％),C组87例(25.2％).3组患者中,心房颤动分别占51/101 (50.5％)、59/157(37.6％)和35/87 (40.2％),3组间差异无统计学意义(x2=4.362,P=0.113);HI型出血所占比例分别为17/101(16.8％)、35/157(22.3％)和18/87(20.7％);PH型出血所占比例分别为5/101(5.0％)、16/157(10.2％)和9/87(10.3％),出血转化的差异无统计学意义(x2=4.278,P=0.370);3组间良好神经功能结局差异无统计学意义[52/101(51.5％),84/157(53.5％),41/87(47.1％),x2=0.913,P=0.633].经多因素校正后发现:C组心房颤动可增加HI型出血风险(OR=1.208,95％ CI0.498～2.930,P=0.677),并发现心房颤动增加B组PH型出血风险(OR=3.757,95％ CI1.133～12.457,P=0.030).心房颤动对神经功能结局无独立影响.结论 合并心房颤动不影响急性缺血性脑卒中患者静脉溶栓后3个月的神经功能结局,但增加时间窗＞3.0h且≤4.5 h溶栓患者的PH型出血风险.
目的 分析不同髮病-溶栓時間窗內,閤併心房顫動對急性缺血性腦卒中患者靜脈溶栓治療後齣血轉化和預後的影響.方法 迴顧性分析2009年6月至2013年10月本科接受靜脈重組組織型纖溶酶原激活劑(rt-PA)溶栓治療的急性缺血性腦卒中患者的資料,根據時間窗分為3組[≤3.0 h(A)、＞3.0h且≤4.5 h(B)和＞4.5 h(C)組,通過多因素分析3組患者心房顫動對溶栓後齣血性梗死(HI)、腦實質齣血(PH)及良好神經功能結跼[改良Rankin量錶評分(mRS)評分≤2分]的影響.結果 共345例患者納入研究,其中A組101例(29.3％),B組157例(45.5％),C組87例(25.2％).3組患者中,心房顫動分彆佔51/101 (50.5％)、59/157(37.6％)和35/87 (40.2％),3組間差異無統計學意義(x2=4.362,P=0.113);HI型齣血所佔比例分彆為17/101(16.8％)、35/157(22.3％)和18/87(20.7％);PH型齣血所佔比例分彆為5/101(5.0％)、16/157(10.2％)和9/87(10.3％),齣血轉化的差異無統計學意義(x2=4.278,P=0.370);3組間良好神經功能結跼差異無統計學意義[52/101(51.5％),84/157(53.5％),41/87(47.1％),x2=0.913,P=0.633].經多因素校正後髮現:C組心房顫動可增加HI型齣血風險(OR=1.208,95％ CI0.498～2.930,P=0.677),併髮現心房顫動增加B組PH型齣血風險(OR=3.757,95％ CI1.133～12.457,P=0.030).心房顫動對神經功能結跼無獨立影響.結論 閤併心房顫動不影響急性缺血性腦卒中患者靜脈溶栓後3箇月的神經功能結跼,但增加時間窗＞3.0h且≤4.5 h溶栓患者的PH型齣血風險.
목적 분석불동발병-용전시간창내,합병심방전동대급성결혈성뇌졸중환자정맥용전치료후출혈전화화예후적영향.방법 회고성분석2009년6월지2013년10월본과접수정맥중조조직형섬용매원격활제(rt-PA)용전치료적급성결혈성뇌졸중환자적자료,근거시간창분위3조[≤3.0 h(A)、＞3.0h차≤4.5 h(B)화＞4.5 h(C)조,통과다인소분석3조환자심방전동대용전후출혈성경사(HI)、뇌실질출혈(PH)급량호신경공능결국[개량Rankin량표평분(mRS)평분≤2분]적영향.결과 공345례환자납입연구,기중A조101례(29.3％),B조157례(45.5％),C조87례(25.2％).3조환자중,심방전동분별점51/101 (50.5％)、59/157(37.6％)화35/87 (40.2％),3조간차이무통계학의의(x2=4.362,P=0.113);HI형출혈소점비례분별위17/101(16.8％)、35/157(22.3％)화18/87(20.7％);PH형출혈소점비례분별위5/101(5.0％)、16/157(10.2％)화9/87(10.3％),출혈전화적차이무통계학의의(x2=4.278,P=0.370);3조간량호신경공능결국차이무통계학의의[52/101(51.5％),84/157(53.5％),41/87(47.1％),x2=0.913,P=0.633].경다인소교정후발현:C조심방전동가증가HI형출혈풍험(OR=1.208,95％ CI0.498～2.930,P=0.677),병발현심방전동증가B조PH형출혈풍험(OR=3.757,95％ CI1.133～12.457,P=0.030).심방전동대신경공능결국무독립영향.결론 합병심방전동불영향급성결혈성뇌졸중환자정맥용전후3개월적신경공능결국,단증가시간창＞3.0h차≤4.5 h용전환자적PH형출혈풍험.
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 We retrospectively reviewed the clinical and imaging data of patients of acute ischemic stroke with intravenous thrombolysis admitted from June 2009 to October 2013.According to onset-to-needle time,we divided patients into 3 groups and then assessed the effect of the comorbidity with atrial fibrillation on the occurrence of hemorrhagic transformation and favorable outcome (defined as modified Rankin Scale score≤2 at 90 days) after thrombolysis within different time window.Results A total of 345 patients were included in this study,among whom 101 (29.3％) were treated by intravenous thrombolysis within 3.0 h (≤3.0 h),157(45.5％) ＞3.0 h and≤4.5 h,87(25.2％) over 4.5 h(＞4.5 h).Atrial fibrillation was observed in 50.5％ (51/101) patients in ≤3.0 h group,37.6％ (59/157) in ＞3.0 h and≤4.5 h group and 40.2％ (35/87) in ＞ 4.5 h group (x2 =4.362,P =0.113).There were no statistically significant differences among these three groups about the rate of hemorrhagic transformation (hemorrhagic infarction:16.8％ (17/101),22.3％ (35/157),20.7％ (18/87),and parenchymal hematoma:5.0％ (5/101),10.2％ (16/157),10.3％ (9/87),x2 =4.278,P =0.370) and favorable outcome (51.5％ (52/101),53.5％ (84/ 157),47.1％ (41/87),x2 =0.913,P =0.633).Multivariate analysis demonstrated that atrial fibrillation was associated with hemorrhagic infarction for patients in ＞ 4.5 h group (OR =3.637,95％ CI 1.101-12.013,P =0.034),and the presence of atrial fibrillation independently predicted parenchymal hematoma for patients in ＞ 3.0 h and ≤4.5 h group (OR =3.757,95％ CI 1.133-12.457,P =0.030).There was no significant association between atrial fibrillation and favorable outcome at 90 days.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 ＞ 3.0 h and ≤4.5h.
