心房颤动合并缺血性脑卒中的危险因素分析

发布时间：2018-06-01 22:24

本文选题：心房颤动 + 脑卒中　；参考：《承德医学院》2017年硕士论文

【摘要】：心房颤动(Atrial fibrillation,AF)简称房颤,是目前在临床上最严重且最常见的的快速心房电活动紊乱。据统计当今世界总人口患病率高达0.08%-1%,且患病率随年龄增长而出现逐渐增高的趋势。当发生心房颤动时,心房由于颤动失去了有效收缩节律,进而导致泵血功能下降或丧失,排血量减少可高达25%以上。随着时间的增加逐渐出现心房纤维化、淀粉沉积,心房结构重构,进而出现心房增大。随着心房增大及血液淤积,局部形成涡流,内皮细胞的损伤,激发一系列的凝血机制,进而促进血栓形成,一旦左心房血栓脱落导致的体循环栓塞,尤其是缺血性脑卒中是房颤栓塞中最严重的并发症之一,它的致残率及致死率是极高的。据统计大约近20%的缺血性脑卒中是由心源性栓子脱离所致,并且已是明确研究得出的。国内外已有多项研究证实,左心房血栓形成与缺血性脑卒中的发生密切相关,而左心房内径的大小与血栓形成密不可分。CHA2DS2-VASc是作为对心房颤动患者缺血性脑卒中(Cerebral ischemic stroke)的风险评估,是2012年欧洲心脏病学会(Eurpopean Society of Cardiology ESC)指南强烈推荐的,但其预测存在一定会局限性的,价值处于中等地位。有大量研究发现目前存在一些血液生化指标及左心房内径可评价缺血性脑卒中发生的风险,联合CHA2DS2-VASc评分可作为脑卒中危险分层新的发展趋势,进一步掌握所致脑卒中的其他危险因素,为预防缺血性脑卒中提出更为系统及合理的临床思路。因此,本文就有关心房颤动合并脑卒中的危险因素做探讨,重点分析左心房内径在内的以及其他临床危险因素与脑卒中发生的关系。目的:探讨心房颤动合并缺血性脑卒中的相关危险因素分析,为更好的预防心房颤动所致的缺血性脑卒中提供有效的防治措施。方法:收集2015年9月-2016年12月在我院心内科及神经内科住院的心房颤动患者共136例,根据是否发生缺血性脑卒中,分为A组非卒中组,66例,B组卒中组,70例。记录患者的一般资料:年龄、性别、合并疾病:高血压病史、糖尿病病史、心力衰竭、心房颤动类型等;辅助检查资料:心脏超声、血液生化指标、甲状腺功能。对一般资料、生化指标及甲状腺功能进行单因素分析,将差异有统计学意义的指标纳入多因素Logistic回归中进行分析,筛选出心房颤动合并缺血性脑卒中的危险因素。结果:1一般资料对比分析得出:卒中组患者的高血压、性别、年龄水平明显高于非卒中组,差异有统计学意义(P0.05)。2血液生化指标及甲状腺功能分析对比:甘油三脂(TG)、低密度脂蛋白(LDL-C)、总胆固醇(TC)、促甲状腺激素(TSH)、同型半胱氨酸(Hcy),卒中组水平明显高于非卒中组;卒中组游离甲状腺素(FT4)水平显著低于非卒中组,差异具有统计学意义(P0.05)3心脏超声指标左心房内径两组对比差异有统计学意义(P0.05),卒中组明显高于非卒中组。4将差异具有统计学意义的风险指标纳入多因素Logistic回归分析中得出:左心房内径大于42mm、高血压病史、总胆固醇水平异常是心房颤动合并缺血性脑卒中的独立危险因素。5两组对比心房颤动类型差异无统计学意义(P0.05)。结论:1一般资料中合并高血压病史是心房颤动合并脑卒中的独立危险因素,积极防治以上因素并制定合理方案以更好的预防脑卒中的发生。2心脏超声指标左心房内径增大是导致缺血性脑卒中的高危因素,临床上应给与积极干预预防恶性事件的发生。3心房颤动类型与缺血性脑卒中的发生无明显关系。4血液生化指标:总胆固醇水平升高是缺血性脑卒中发生的危险因素5 TSH及FT4,两组对比存在显著差异,缺血性脑卒中的发生在一定程度上可能与TSH及FT4有关系。
[Abstract]:Atrial fibrillation (AF), referred to as atrial fibrillation, is the most serious and most common rapid atrial electrical disturbance at present. According to statistics, the prevalence rate of total population in the world is up to 0.08%-1%, and the prevalence rate increases with age. The contraction rhythm leads to the decrease or loss of blood pump function. The decrease of blood discharge can be as high as 25%. As time goes on, there is a gradual appearance of atrial fibrosis, starch deposition, remodeling of the atrium, and atrium enlargement. With the enlargement of the atrium and blood stasis, the local formation of eddy current, endothelial cell damage, and a series of coagulation mechanisms are stimulated. To promote thrombosis, systemic circulation embolism caused by left atrial thrombus falling off, especially ischemic stroke, is one of the most serious complications of atrial fibrillation embolism. Its disability rate and mortality rate are very high. According to statistics, approximately 20% of ischemic stroke is caused by cardiogenic suppositories and has been clearly studied. Many studies have confirmed that the formation of left atrial thrombus is closely related to the occurrence of ischemic stroke, and the size of the left atrium is closely related to the formation of thrombus formation as a risk assessment for ischemic stroke (Cerebral ischemic stroke) in patients with atrial fibrillation, and the European Heart Association (Eurpopean So) in 2012 (Eurpopean So). Ciety of Cardiology ESC) guidelines are strongly recommended, but their predictions are limited and of medium value. There are numerous studies that present some blood biochemical markers and left atrium diameters to assess the risk of ischemic stroke, combined with the CHA2DS2-VASc score as a new trend in the risk stratification of stroke. To further master the other risk factors of cerebral apoplexy and to put forward more systematic and reasonable clinical ideas for the prevention of ischemic stroke. Therefore, this article is to discuss the risk factors of atrial fibrillation and stroke, focus on the analysis of the internal diameter of the left atrium, and the relationship between his clinical risk factors and the occurrence of stroke. To explore the related risk factors of atrial fibrillation and ischemic stroke, and to provide effective prevention and control measures for the better prevention of ischemic stroke caused by atrial fibrillation. Methods: 136 cases of atrial fibrillation patients in the Department of Cardiology and neurology department of our hospital in September 2015, -2016 years, were collected, according to the occurrence of ischemic stroke. It was divided into group A non stroke group, 66 cases, group B stroke group, 70 cases. Age, sex, combined disease: hypertension history, diabetes history, heart failure, atrial fibrillation type and so on; auxiliary examination data: cardiac ultrasound, blood biochemical index, thyroid function. General data, biochemical indicators and thyroid function were carried out. Factors analysis, the difference of statistically significant indicators into the multiple factor Logistic regression analysis, screening out the risk factors of atrial fibrillation and ischemic stroke. Results: 1 general data comparison and analysis showed that hypertension, sex, age of patients in the stroke group were significantly higher than those in non stroke group, the difference was statistically significant (P0.05).2 Blood biochemical indexes and thyroid function analysis were compared: glycerol three fat (TG), low density lipoprotein (LDL-C), total cholesterol (TC), thyroid stimulating hormone (TSH), homocysteine (Hcy), and stroke group were significantly higher than those in non stroke group, and the level of free thyroid hormone (FT4) in stroke group was significantly lower than that in non stroke group, and the difference was statistically significant (P0.05) 3 heart. The difference of left atrium diameter in two groups was statistically significant (P0.05), and the stroke group was significantly higher than that of non stroke group (.4). The risk index of difference was statistically significant in multiple factor Logistic regression analysis. The left atrium diameter was greater than 42mm, the history of hypertension and the abnormal total cholesterol level were atrial fibrillation and ischemic brain. There was no significant difference in the type of atrial fibrillation in.5 two groups (P0.05). Conclusion: 1 in general data, the history of hypertension combined with hypertension is an independent risk factor for atrial fibrillation combined with stroke, actively preventing the above factors and formulating a reasonable plan to better prevent the occurrence of stroke in the left atrium by.2 echocardiography. The increase of internal diameter is the high risk factor of ischemic stroke, and there is no significant relationship between the type of.3 atrial fibrillation and the occurrence of ischemic stroke in clinic. There is no significant relationship between the.4 blood biochemical indexes: the increase of total cholesterol level is 5 TSH and FT4 for the occurrence of ischemic stroke, and there is a significant contrast between the two groups. The occurrence of ischemic stroke may be related to TSH and FT4 to some extent.
【学位授予单位】：承德医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.75;R743.3

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