影响脑梗死患者伴发心律失常-房颤的危险因素分析

Risk factors for arrhythmia-atrial fibrillation in patients with cerebral infarction

摘要:

分析影响脑梗死患者伴发心律失常- 房颤的危险因素，以期改善脑梗死患者预后。方法回顾性调查统计南阳市中心医院2014 年1 月-2015 年10 月收治的96 例脑梗死患者的临床资料，其中脑梗死后伴发心律失常- 房颤的患者共有23 例，记为观察组；其余73 例未发生心律失常- 房颤的患者记为对照组。对两组可能影响心率失常- 房颤发生的因素分别采用单因素两样本比较和多因素Logistic 回归分析方法确定其影响因素，以期为临床脑梗死患者预后改善提供依据。结果年龄≥70 岁、心律失常- 房颤家族史、大面积脑梗死、NIHSS 评分≥16 分、合并高血压、合并糖尿病、心功能III～IV 级、抗凝治疗、服用溶栓药物、脑梗死手术治疗、LAD≥45 mm、LEVDD≥50 mm、颈动脉软斑块、适当锻炼等均是脑梗死患者伴发心律失常- 房颤的影响因素（p <0.05）；多因素Logistic 回归分析发现，影响脑梗死患者伴发心律失常- 房颤的危险因素按照危险程度由高到低排列为大面积脑梗死（OR =3.987）、颈动脉软斑块（OR =3.246）、NIHSS 评分≥16分（OR =3.214）、合并高血压（OR =2.067）、年龄≥70 岁（OR =1.932），而抗凝治疗、服用溶栓药物、脑梗死手术治疗、适当锻炼均是脑梗死患者伴发心律失常- 房颤的保护性因素（b<0，0

Abstract:

To analyze the risk factors for arrhythmia -atrial fibrillation in patients with cerebral infarction, in order to improve the prognosis of the patients. Methods Clinical data of 96 patients with cerebral infarction treated in Nanyang Central Hospital of Henan Province were investigated and retrospectively figured.Twenty -three patients with arrhythmia -atrial fibrillation after cerebral infarction were enrolled into observation group, and seventy-three cases without arrhythmia-atrial fibrillation were enrolled into control group. The factors that might affect arrhythmia-atrial fibrillation were analyzed by single-factor two-sample comparison, and multivariate logistic regression analysis was used to confirm the risk factors. Results The factors influencing arrhythmia-atrial fibrillation of the patients with cerebral infarction included age of 70 years or older, a family history of cardiac arrhythmia -atrial fibrillation, massive cerebral infarction, NIHSS score of 16 points or more, complication with hypertension, complication with diabetes, cardiac function of III -IV grades, anti -coagulation therapy, taking thrombolytic drugs, surgical treatment of cerebral infarction, LAD more than or equal to 45 mm, LEVDD more than or equal to 50 mm, carotid soft plaque, proper exercise, etc (p < 0.05). Multivariate logistic regression analysis showed the risk factors for arrhythlow according to the risk degree were massive cerebral infarction (OR = 3.987), soft plaque of carotid artery (OR =3.246), NIHSS score more than or equal to 16 points (OR = 3.214), combination with hypertension (OR = 2.067)and age more than or equal to 70 years (OR = 1.932). Factors such as anticoagulant therapy, thrombolytic therapy, cerebral infarction surgery, and proper exercise were the protective factors of arrhythmia-atrial fibrillation in the patients with cerebral infarction (b < 0, 0 < OR <1, p< 0.05). Conclusions There are various kinds of risk factors for arrhythmia-atrial fibrillation in patients with cerebral infarction. In clinic, measures should be taken for patients with large area cerebral infarction, carotid artery soft plaque, NIHSS score more than or equal to 16 points and combination with hypertension; at the same time anti-platelet aggregation and thrombolytic drugs should be given and appropriate exercise should be instructed to reduce the incidence of arrhythmia-atrial fibrillationmia-atrial fibrillation .