心房颤动患者心脏导管射频消融术后急性缺血性脑卒中发病率及其影响因素研究

发布时间：2018-05-15 15:12

本文选题：心房颤动 + 心脏射频消融术　；参考：《中国全科医学》2016年20期

【摘要】：目的探讨心房颤动患者心脏导管射频消融术(RFCA)后住院期间急性缺血性脑卒中的发病率及其影响因素。方法回顾性分析2012年1月—2015年12月北京安贞医院心内科出院诊断中包括"阵发性或持续性心房颤动"并实施RFCA的住院患者4 573例,根据RFCA后住院期间是否发生急性缺血性脑卒中分为卒中组及对照组,记录患者的性别、年龄、既往史和合并症、心房颤动类型、手术次数、住院时间、院内病死率、入院及出院时日常生活能力(ADL)评分。结果 4 573例发生急性缺血性脑卒中患者22例(卒中组),发病率为0.48%,其中脑梗死19例(0.41%),短暂性脑缺血发作(TIA)3例(0.07%);其余4 551例未发生急性缺血性脑卒中患者为对照组。对照组与卒中组患者性别、年龄、既往高血压、糖尿病、高脂血症、冠心病、心脏瓣膜病发病率、手术次数比较,差异均无统计学意义(P0.05);对照组与卒中组患者既往缺血性脑卒中、心功能不全发病率、心房颤动类型比较,差异均有统计学意义(P0.05)。多因素Logistic回归分析结果显示,既往缺血性脑卒中病史〔OR=21.342,95%CI(6.549,69.546)〕、心功能不全〔OR=8.782,95%CI(3.173,24.308)〕、持续性心房颤动〔OR=2.990,95%CI(1.137,7.860)〕是心房颤动患者RFCA后住院期间并发急性缺血性脑卒中的独立危险因素(P0.05)。卒中组患者住院时间长于对照组〔13(24)d与5(2)d〕,院内病死率高于对照组〔9.09%(2/22)与0.13%(6/4 551)〕,出院时ADL评分低于对照组〔(89.8±14.6)分与(99.1±4.1)分〕(P0.05)。结论心房颤动患者RFCA后住院期间急性缺血性脑卒中总体发病率较低,但并发急性缺血性脑卒中延长了住院时间,增加了院内病死率,影响患者生活能力;既往缺血性脑卒中病史、心功能不全、持续性心房颤动是RFCA后住院期间并发急性缺血性脑卒中的独立危险因素,术前筛选和严格掌握适应证有助于减少RFCA后并发急性缺血性脑卒中。
[Abstract]:Objective to investigate the incidence and influencing factors of acute ischemic stroke after radiofrequency catheter ablation (RFCA) in patients with atrial fibrillation. Methods from January 2012 to December 2015, 4 573 patients with paroxysmal or persistent atrial fibrillation (PAF) and RFCA were analyzed retrospectively. According to whether acute ischemic stroke occurred during hospitalization after RFCA, patients were divided into two groups: stroke group and control group. Sex, age, past history and complications, type of atrial fibrillation, number of operations, length of hospitalization, mortality in hospital were recorded. ADL score on admission and discharge. Results the incidence of acute ischemic stroke was 0.48 in 4 573 patients (stroke group), 19 patients with cerebral infarction, 3 patients with transient ischemic attack, and 4 551 patients without acute ischemic stroke as control group. Sex, age, past hypertension, diabetes mellitus, hyperlipidemia, coronary heart disease, heart valve disease, operation times were compared between control group and stroke group. There was no significant difference between control group and stroke group in the incidence of cardiac insufficiency and the type of atrial fibrillation. There was significant difference between control group and stroke group in the incidence of cardiac insufficiency and the type of atrial fibrillation. The results of multivariate Logistic regression analysis showed that the past history of ischemic stroke was 21.342CII 6.549 / 69.546C, the heart failure was 8.78295 / 95 CI 3.17324.308%, and the persistent atrial fibrillation was 2.9907.860% (CI 1.1377.860) was an independent risk factor of acute ischemic stroke after RFCA hospitalization in patients with atrial fibrillation (P0.05). The hospital stay in the stroke group was longer than that in the control group, and the hospital mortality was higher than that in the control group (9.09 / 22) and 0.1313 / 4 551 (P < 0.01). The ADL score at discharge was lower than that in the control group (89.8 卤14.6) and 99.1 卤4.1 (P < 0.01). Conclusion the overall incidence of acute ischemic stroke after RFCA in patients with atrial fibrillation is lower, but the complication of acute ischemic stroke prolongs the hospitalization time, increases the hospital mortality and affects the living ability of the patients. Previous history of ischemic stroke, cardiac insufficiency and persistent atrial fibrillation were independent risk factors for acute ischemic stroke during hospitalization after RFCA. Preoperative screening and strict indication are helpful to reduce acute ischemic stroke after RFCA.
【作者单位】：首都医科大学附属北京安贞医院神经内科北京心肺血管疾病研究所;
【分类号】：R541.75;R743.3

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