心房颤动相关脑卒中78例临床分析.docVIP

精品论文 参考文献 心房颤动相关脑卒中78例临床分析 许北柱 伍伟锋 　　【摘 要】 目的 探讨心房颤动（简称房颤）相关脑卒中患者的临床特点。方法 选择住院的房颤伴急性脑梗死患者（房颤相关脑卒中组）78例，同期住院的动脉硬化血栓形成性急性脑梗死患者（脑血栓组）52例作为对照。收集患者的基本资料、临床表现以及经胸超声心动图（TTE）、头颅CT/MR及外周血中血小板等相关指标，并进行对比分析。结果 1. 房颤相关脑卒中组发病年龄与脑血栓组相比无显著差异（P＞0.05），但房颤相关脑卒中组女性患者比例高（P＜0.05），合并器质性心脏病比例高（P＜0.05），有高血压、糖尿病及吸烟等危险因素少（P＜0.05），血TC、LDL、HCY水平明显低（P＜0.05）。2.房颤相关脑卒中组60例患者TTE检查发现11例有左心房血栓，占18.3%，而脑血栓组未发现左心房血栓患者。房颤相关脑卒中组左房内径（LAD）显著大于脑血栓组（P＜0.05），而左室舒末内径（LVEDD）、室间隔厚度（IVST）及左室射血分数（LVEF）＜50%患者百分比两组间无明显差别（P＞0.05）。3． 房颤相关脑卒中组的大面积脑梗塞及梗塞后出血性转化发生率比脑血栓组更高（P＜0.05）。4． 与脑血栓组相比，房颤相关脑卒中组患者的血小板计数（PLT）、血小板压积（PCT）及血小板体积分布宽度（PDW）等指标没有明显差异（P＞0.05），但血小板平均体积（MPV）显著增高（P＜0.05）。5． 房颤相关脑卒中组住院死亡或因病情加重自动出院者比脑血栓组更多见（P＜0.05）。结论 房颤相关脑卒中患者以女性多见，多合并器质性心脏病，心血管危险因素少。房颤相关脑卒中患者左房增大，部分患者有左房血栓，外周血中MPV明显增高。房颤相关脑卒中患者大面积脑梗死和梗死后出血性转化发生率高，住院死亡率高。 　　【关键词】 心房颤动； 脑卒中； 血小板平均体积； 左房 　　【Abstract】 Methods The patients with both acute ischemic stroke and AF(abbreviation for atrial fibrillation) who were hospitalized in our hospital were selected as AF-related Stroke Group.Within this group,there were 78 cases of patients.In addition,52 cases of patients who were hospitalized in our hospital over the same period with acute ischemic stroke (arteriosclerotic cerebral thrombosis) but without AF were selected as Thrombosis Group(as controls).Collected the basic data, clinical manifestations and relevant parameters of transthoracic echocardiography (TTE), brain CT/MR and platelets(in peripheral vein blood) from the patients and used the comparative analysis methods to analyse them.Results 1. The age of onset of the AF-related Stroke Group was not significantly different from that of the Thrombosis Group(P＞0.05).But the female proportion of the AF-related Stroke Group was higher(P lt; 0.05) and the AF-related Stroke Group showed a higher proportion of organic heart disease (P lt; 0.05). The risk factors such as hypertension, diabetes and smoke were found less in the AF-related Stroke Group than in the controls(P lt; 0.05).Compared with the