中老年急性脑血管病并发脑心综合征125例临床分析

王淑银++王一书++李云++王伟力

[摘要] 目的 探討中老年脑心综合征（CCS）在急性脑血管病（ACVD）中的发病率、影响因素、临床特点及防治措施。 方法 回顾性分析2000年10月～2016年10月北京小汤山医院收治的204例ACVD患者的临床资料。观察患者的病变类型、部位、心电图及心肌酶谱变化、生化指标、治疗及转归。 结果 本组患者合并CCS 125例，其中，男76例，女49例，CCS发病率为61.3%。出血性脑血管病（脑出血、蛛网膜下腔出血）CCS发生率明显高于缺血性脑血管病，差异有高度统计学意义（P < 0.01）；大脑深部病变（脑干与小脑、丘脑与基底节）CCS发生率明显高于大脑半球病变，差异有高度统计学意义（P < 0.01）。心电图变化，包括肌缺血改变、各种心律失常。实验室检查显示心肌酶升高、电解质紊乱、血糖异常。合并CCS患者的死亡率明显高于无CCS患者，差异有高度统计学意义（P < 0.01）。 结论 中老年CCS的发生与脑血管病类型、部位、疾病转归有关，掌握CCS的临床特点，对临床判断预后及正确治疗有指导意义。

[关键词] 中老年；急性脑血管病；脑心综合征；临床特点

[中图分类号] R743.3 [文献标识码] A [文章编号] 1673-7210（2017）07（b）-0086-04

Clinical analysis of acute cerebrovascular disease combined with cerebro-cardiac syndrome in 125 cases of middle-aged and elderly

WANG Shuyin WANG Yishu LI Yun WANG Weili▲

Department of General Medical， Beijing Xiaotangshan Hospital， Beijing 102211， China

[Abstract] Objective To discuss the incidence， influential factors， clinical characteristics and preventive measures of cerebro-cardiac syndrome （CCS） in acute cerebrovascular disease （ACVD） patients of middle-aged and elderly. Methods The clinical data of 204 patients with ACVD treated in Beijing Xiaotangshan Hospital from October 2000 to October 2016 were analyzed retrospectively. The disease types， location， changes of electrocardiogram & myocardial enzymes， biochemical indexes， treatment and prognosis were observed. Results There were 125 cases combined with CCS， with incidence of 61.3%. There were 76 male and 49 female. The incidence of CCS in hemorrhagic cerebrovascular disease （intracerebral hemorrhage and subarachnoid hemorrhage） was significantly higher than that in ischemic cerebrovascular disease， with statistically significant difference （P < 0.01）. The incidence of CCS in deep brain lesions （brain stem and cerebellum， thalamus and basal ganglia） was significantly higher than that in cerebral hemisphere lesions， with statistically significant difference （P < 0.01）. Patients with CCS had electrocardiogram changes， including myocardial ischemia change， various arrhythmia. The results of laboratory examination showed that elevated myocardial enzymes， abnormal electrolyte and pathoglycemia. Mortality of the patients combined with CCS was significantly higher than that of patients without CCS （P < 0.01）. Conclusion The occurrence of CCS is related with the disease types， location and outcomes of the disease. There is a guiding significance for the prognosis judgment of patients with ACVD and correct therapy by grasping the clinical characteristics of CCS.

[Key words] Middle-aged and elderly； Acute cerebrovascular disease； Cerebro-cardiac syndrome； Clinical characteristics

急性脑血管病（ACVD）是临床常见病、多发病[1]，本病发病急、致死率高[2]，亦是老年人致残的主要原因之一。据国外统计，ACVD已成为较发达国家致死和致残的主要原因[3]。近年来，ACVD发病年龄有年轻化趋势，在临床工作中，经常遇到脑血管病急性期，患者出现类似心肌缺血、心肌梗死、心律失常等临床表现，统称为脑心综合征（CCS）[4]。出血及缺血性脑血管病，均可继发CCS[5]，尤其是出血性脑血管病时，使治疗产生矛盾，导致病情加重，给临床医生带来困惑，能否及时识别及正确处理，直接影响患者康复与生存率。北京小汤山医院（以下简称“我院”）近十余年来共收治急性脑血管病204例，其中，诊断为CCS 125例，现将临床资料进行分析，以期及时正确治疗，达到最佳疗效。

1 资料与方法

1.1 一般资料

回顾性分析2000年10月～2016年10月我院收治的204例AVCD患者，均符合1995年全国第四届脑血管病学术会议制订的诊断标准[6]，并均经头颅CT或MRI检查证实。……