老年人急性脑卒中引起脑心综合征416例分析

目的: 探讨老年人脑卒中后脑心综合征(BHS)的临床特点及发病机制。方法: 对416例老年人急性脑卒中后BHS患者的临床资料进行回顾性分析。结果: 老年人BHS发生率为38.6%,明显高于同期中青年BHS发生率(17.4%)(P<0.01),98% BHS老年患者于脑卒中后2小时~1周内发生;其发生与卒中类型、病变部位有关;出血性脑卒中发生BHS明显高于缺血性脑卒中(P<0.005)。BHS心电图主要表现为心律失常、心肌缺血和类心肌梗死;心肌酶谱异常率为35.6%,57.9%合并低钾血症或低钠血症;病死率为30.29%,明显高于未合并BHS的脑卒中患者(15.26%)(P<0.005)。结论: 早期诊断,解除高颅压,加强心电监护,预防心衰,及时纠正心律失常是治疗的重要环节。

Brain-heart syndrome of aged patients with acute stroke:A report of 416 cases

Objective:To investigate the clinical significance and mechanism of brain-heart syndrome (BHS) in the aged with acute stroke.Methods:The clinical data of 416 cases of BHS of the aged with acute stroke were analyzed retrospectively.Results:The incidence of BHS in the aged(38.6%) was higher than that in the young persons (17.4%)(P<0.01),and the occurrence of BHS in98% old patients was in the first week of stroke.The occurrence of BHS was associated with stroke type and lesion location.BHS was found more commonly in acute stroke of brain hemorrhage (76.5%) than in that of embolism(51.3%)(P< 0.01).The features of BHS EKG were arrhythmia,similarity myocardial infarction and myocardial ischemia.The abnormality rate of myocardial enzyme was about 46.6%,and about 49% of BHS was associated with low potassium or sodium.The mortality rate of the aged with BHS was 30.29%,which was higher than that of the young persons with BHS(15.15% )and the aged without BHS(15.26%)(P< 0.005).Conclusions:The key to the treatment of BHS of aged patients with acute stroke is early diagnosis,high ICP release,EKG monitoring,prevention of pump failure and timely adjustment of arrhythmia.