心房颤动对不同时间窗内急性缺血性脑卒中患者静脉溶栓疗效的影响

目的探讨急性缺血性脑卒中合并心房颤动患者不同时间窗内静脉溶栓的疗效差异。方法选取急性缺血性脑卒中行静脉溶栓治疗患者172例,根据发病-溶栓时间窗差异分为3组,时间窗分别为≤3.0 h(观察A组)、>3.0~4.5 h(观察B组)、>4.5 h(观察C组),对其中合并心房颤动者溶栓疗效进行评估分析。结果3组患者溶栓24 h后出血转化结果、溶栓3个月时神经功能结局良好率、病死率均无明显差异(P>0.05);溶栓时间窗>3 h者,心房颤动可显著增加患者发生PH型、HI型出血转化发生率,差异有统计学意义(P<0.05);单因素分析显示,合并心房颤动可造成溶栓时间窗≤4.5 h患者神经功能结局不良发生率增加,差异有统计学意义(P<0.05)。多因素分析显示,合并心房颤动与不同时间窗急性缺血性脑卒中患者静脉溶栓治疗后神经功能结局不良发生情况无明显相关性(P>0.05)。结论溶栓时间窗仍是影响急性缺血性脑卒中患者静脉溶栓疗效的重要因素,对于溶栓时间窗≤3.0 h者,合并心房颤动不会对溶栓疗效造成影响;对于发病-溶栓时间>3 h者,心房颤动可能造成患者溶栓后出血风险增加。

Effect of atrial fibrillation on the efficacy of intravenous thrombolysis in patients with acute ischemic stroke in different time windows

Objective To investigate the difference in the efficacy of intravenous thrombolysis in patients with acute ischemic stroke combined with atrial fibrillation at different time points.Methods 172 patients with acute ischemic stroke treated with intravenous thrombolysis were selected.According to the difference of the onset-thrombolytic time window,the time window was divided into three groups.≤3.0h(observation group A),>3.0-4.5h(observation group B),and>4.5h(observation group C),evaluate the efficacy of thrombolysis in patients with atrial fibrillation.Results There were no significant differences in the results of hemorrhage conversion after thrombolysis for 24 hours,the good rate of neurological outcomes at 3 months after thrombolysis,and the mortality rate(P>0.05).Atrial fibrillation significantly increased patients with thrombolysis time window greater than 3h.The incidence of PH-type and HI-type hemorrhagic transformation occurred,the difference was statistically significant(P<0.05).The analysis of factors showed that the combined atrial fibrillation caused the incidence of neurological failure in patients with thrombolysis time window≤4.5h,and the difference was statistically significant.Academic significance(P<0.05).Multivariate analysis showed that there was no significant correlation between the occurrence of atrial fibrillation and neurological deficits after intravenous thrombolysis in patients with acute ischemic stroke at different time windows(P>0.05).Conclusion Thrombolytic time window is still an important factor affecting the efficacy of intravenous thrombolysis in patients with acute ischemic stroke.For patients with thrombolysis time window≤3.0h,combined atrial fibrillation will not affect the efficacy of thrombolysis in patients;For more than 3 hours,atrial fibrillation may increase the risk of bleeding after thrombolysis.