龚家俊?王文敏

【摘要】目的 探討急性脑卒中后脑心综合征（CCS）的临床特点及其对患者预后的影响。方法 选择150例急性脑卒中后患者，分为脑梗死组52例、脑出血组51例、蛛网膜下腔出血组47例。所有患者均行心电图、实验室检查以及在内科基础上进行保护心肌治疗。治疗完成后，比较2组患者的心电图变化情况、CCS的发病率、心肌酶变化，并随访6个月，比较有无CCS的急性脑卒中患者病死率的差异。结果 脑出血组和蛛网膜下腔出血组的心律失常及入院第3日心肌酶异常发生率均高于脑梗死组（P均< 0.017）。脑梗死组、脑出血组、蛛网膜下腔出血的CCS发生率分别为6%、20%、38%，蛛网膜下腔出血组的CCS发生率高于脑梗死组（P < 0.017）。随访6个月，发生CCS的急性脑卒中患者病死率为58%，高于未发生CCS患者的20%（P < 0.001）。结论 急性脑卒中尤其是出血性脑卒中后患者较易出现CCS，造成患者的不良预后，需重视对该类患者心功能的监测，若患者出现CCS，应立即调整治疗方案控制CCS病情，以改善患者的预后。

【关键词】急性脑卒中;脑心综合征;临床特点;预后;心电图变化

Clinical characteristics of cerebro-cardiac syndrome and its effect on clinical prognosis of patients with acute stroke Gong Jiajun， Wang Wenmin. Department of Neurology， Dehongzhou Peoples Hospital， Mangshi 678400， China

Corresponding author， Gong Jiajun， E-mail： yndhgjj@ 163. com

【Abstract】Objective To explore the clinical characteristics of cerebro-cardiac syndrome （CCS） and its effect on clinical prognosis of patients with acute stroke. Methods A total of 150 patients with acute stroke were recruited and divided into the cerebral infarction group （n = 52）， cerebral hemorrhage group （n = 51） and subarachnoid hemorrhage group （n = 47）. All patients received electrocardiogram （ECG）， laboratory examination， and myocardial protection treatment based on internal medicine therapy. After corresponding treatment， the ECG changes， the incidence of CCS and changes in myocardial enzymes were compared between two groups. During 6-month follow-up， the mortality rate of acute stroke patients with and without CCS was statistically compared. Results The incidence of arrhythmia and abnormal myocardial enzymes on the 3rd day of admission in the cerebral hemorrhage and subarachnoid hemorrhage groups was significantly higher compared with that in the cerebral infarction group （all P < 0.017）. The incidence of CCS in the cerebral infarction， cerebral hemorrhage and subarachnoid hemorrhage groups was 6%， 20% and 38%. The incidence of CCS in the subarachnoid hemorrhage group was significantly higher than that in the cerebral infarction group （P < 0.017）. During 6-month follow-up， the mortality rate of acute stroke patients with CCS was 58%， significantly higher than 20% in their counterparts without CCS （P < 0.001）. Conclusions Patients with acute stroke， especially after hemorrhagic stroke， are prone to CCS， which can lead to poor prognosis. Extensive attention should be paid to the monitoring of cardiac function of these patients. If CCS occurs， the therapeutic regime should be adjusted immediately to control the condition of CCS， aiming to improve clinical prognosis of patients.

【Key words】Acute stroke;Cerebro-cardiac syndrome;Clinical characteristics;Prognosis;

Electrocardiogram change

急性脑卒中往往损害患者的自主神经中枢功能，其病灶主要位于脑干以及下丘脑，部分患者可出現心肌酶谱升高[1]。脑心综合征（CCS）是当急性脑部疾病累及下丘脑、脑干自主神经中枢时引起的各种心脏功能障碍（如AMI、心内膜下出血、心律失常、心肌缺血或心力衰竭等）的统称[2-3]。CCS常见病因为急性脑血管病和脑外伤，其心电图的异常随着脑部疾病的治疗可逐渐好转[2-4]。CCS是造成急性脑卒中患者死亡的主要原因[5]。因此，在急性脑卒中后早期识别CCS，并予积极干预，对改善预后尤为重要[6]。为此，本研究探讨急性脑卒中后患者发生CCS的临床特点及对预后的影响，为临床相关病例的诊治提供参考，现报告如下。

对象与方法

一、研究对象

选取2017年1月至2018年12月在我院进行治疗的急性脑卒中患者150例，均符合1995年第四届全国脑血管病会议关于急性脑卒中的诊断标准，且患者处于急性期，并经MRI、头颅CT或者腰椎穿刺等方式确诊[7]。……