本文選題：心房顫動 + 腦卒中�。� 參考：《承德醫(yī)學(xué)院》2017年碩士論文

【摘要】：心房顫動(Atrial fibrillation,AF)簡稱房顫,是目前在臨床上最嚴(yán)重且最常見的的快速心房電活動紊亂。據(jù)統(tǒng)計當(dāng)今世界總?cè)丝诨疾÷矢哌_(dá)0.08%-1%,且患病率隨年齡增長而出現(xiàn)逐漸增高的趨勢。當(dāng)發(fā)生心房顫動時,心房由于顫動失去了有效收縮節(jié)律,進而導(dǎo)致泵血功能下降或喪失,排血量減少可高達(dá)25%以上。隨著時間的增加逐漸出現(xiàn)心房纖維化、淀粉沉積,心房結(jié)構(gòu)重構(gòu),進而出現(xiàn)心房增大。隨著心房增大及血液淤積,局部形成渦流,內(nèi)皮細(xì)胞的損傷,激發(fā)一系列的凝血機制,進而促進血栓形成,一旦左心房血栓脫落導(dǎo)致的體循環(huán)栓塞,尤其是缺血性腦卒中是房顫栓塞中最嚴(yán)重的并發(fā)癥之一,它的致殘率及致死率是極高的。據(jù)統(tǒng)計大約近20%的缺血性腦卒中是由心源性栓子脫離所致,并且已是明確研究得出的。國內(nèi)外已有多項研究證實,左心房血栓形成與缺血性腦卒中的發(fā)生密切相關(guān),而左心房內(nèi)徑的大小與血栓形成密不可分。CHA2DS2-VASc是作為對心房顫動患者缺血性腦卒中(Cerebral ischemic stroke)的風(fēng)險評估,是2012年歐洲心臟病學(xué)會(Eurpopean Society of Cardiology ESC)指南強烈推薦的,但其預(yù)測存在一定會局限性的,價值處于中等地位。有大量研究發(fā)現(xiàn)目前存在一些血液生化指標(biāo)及左心房內(nèi)徑可評價缺血性腦卒中發(fā)生的風(fēng)險,聯(lián)合CHA2DS2-VASc評分可作為腦卒中危險分層新的發(fā)展趨勢,進一步掌握所致腦卒中的其他危險因素,為預(yù)防缺血性腦卒中提出更為系統(tǒng)及合理的臨床思路。因此,本文就有關(guān)心房顫動合并腦卒中的危險因素做探討,重點分析左心房內(nèi)徑在內(nèi)的以及其他臨床危險因素與腦卒中發(fā)生的關(guān)系。目的:探討心房顫動合并缺血性腦卒中的相關(guān)危險因素分析,為更好的預(yù)防心房顫動所致的缺血性腦卒中提供有效的防治措施。方法:收集2015年9月-2016年12月在我院心內(nèi)科及神經(jīng)內(nèi)科住院的心房顫動患者共136例,根據(jù)是否發(fā)生缺血性腦卒中,分為A組非卒中組,66例,B組卒中組,70例。記錄患者的一般資料:年齡、性別、合并疾病:高血壓病史、糖尿病病史、心力衰竭、心房顫動類型等;輔助檢查資料:心臟超聲、血液生化指標(biāo)、甲狀腺功能。對一般資料、生化指標(biāo)及甲狀腺功能進行單因素分析,將差異有統(tǒng)計學(xué)意義的指標(biāo)納入多因素Logistic回歸中進行分析,篩選出心房顫動合并缺血性腦卒中的危險因素。結(jié)果:1一般資料對比分析得出:卒中組患者的高血壓、性別、年齡水平明顯高于非卒中組,差異有統(tǒng)計學(xué)意義(P0.05)。2血液生化指標(biāo)及甲狀腺功能分析對比:甘油三脂(TG)、低密度脂蛋白(LDL-C)、總膽固醇(TC)、促甲狀腺激素(TSH)、同型半胱氨酸(Hcy),卒中組水平明顯高于非卒中組;卒中組游離甲狀腺素(FT4)水平顯著低于非卒中組,差異具有統(tǒng)計學(xué)意義(P0.05)3心臟超聲指標(biāo)左心房內(nèi)徑兩組對比差異有統(tǒng)計學(xué)意義(P0.05),卒中組明顯高于非卒中組。4將差異具有統(tǒng)計學(xué)意義的風(fēng)險指標(biāo)納入多因素Logistic回歸分析中得出:左心房內(nèi)徑大于42mm、高血壓病史、總膽固醇水平異常是心房顫動合并缺血性腦卒中的獨立危險因素。5兩組對比心房顫動類型差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:1一般資料中合并高血壓病史是心房顫動合并腦卒中的獨立危險因素,積極防治以上因素并制定合理方案以更好的預(yù)防腦卒中的發(fā)生。2心臟超聲指標(biāo)左心房內(nèi)徑增大是導(dǎo)致缺血性腦卒中的高危因素,臨床上應(yīng)給與積極干預(yù)預(yù)防惡性事件的發(fā)生。3心房顫動類型與缺血性腦卒中的發(fā)生無明顯關(guān)系。4血液生化指標(biāo):總膽固醇水平升高是缺血性腦卒中發(fā)生的危險因素5 TSH及FT4,兩組對比存在顯著差異,缺血性腦卒中的發(fā)生在一定程度上可能與TSH及FT4有關(guān)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.
【學(xué)位授予單位】：承德醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.75;R743.3

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