Christensen Hanne, Fogh Christensen Anders, Boysen Gudrun
Dept. of Neurology, Bispebjerg Hospital, University of Copenhagen 2400 Copenhagen NV, Denmark.
J Neurol Sci. 2005 Jul 15;234(1-2):99-103. doi: 10.1016/j.jns.2005.03.039.
ECG is a useful tool in monitoring vital functions in patients with acute stroke; however, fairly little evidence is available concerning the prevalence and the prognostic impact of ECG findings in patients with acute cerebral infarction and acute intracerebral haemorrhage (ICH).
This analysis was based on data from 692 patients with acute cerebral infarction, 155 patients with intracerebral haemorrhage (ICH), and 223 patients with transient ischaemic attack (TIA), who were admitted to hospital within 6 h of symptom onset. A 12 lead ECG was obtained on admission, and the patient was on telemetry for the first 12-24 h of hospitalisation.
ECG abnormalities were observed in 60% of patients with cerebral infarction, 50% of patients with ICH, and 44% of patients with TIA. In multivariate analyses 3-month mortality in patients with ischaemic stroke was predicted by atrial fibrillation OR 2.0 (95% CI 1.3-3.1), atrio-ventricular block OR 1.9 (95% CI 1.2-3.9), ST-elevation OR (2.8, 95% CI 1.3-6.3), ST-depression OR 2.5 (95% CI 1.5-4.3), and inverted T-waves OR 2.7 (95% CI 1.6-4.6). This was independent of stroke severity, pre-stroke disability and age. In patients with ICH, sinus tachycardia OR 4.8 (95% CI 1.7-14.0), ST-depression OR 5.2 (95% CI 1.1-24.9), and inverted T-wave 5.2 (95% CI 1.2-22.5) predicted poor outcome. None of the changes reached significance in patients with TIA. In patients with severe cerebral infarction or ICH, heart rate did not decrease within the first 12 h after admission, which was the case in patients with mild to moderate stroke. Rapid heart rate predicted 3-month mortality in multivariate testing OR 1.7 (95% CI 1.02-2.7).
ECG abnormalities are frequent in acute stroke and may predict 3-month mortality.
心电图是监测急性脑卒中患者生命体征的有用工具；然而，关于急性脑梗死和急性脑出血（ICH）患者心电图表现的发生率及其预后影响的证据相当有限。
本分析基于692例急性脑梗死患者、155例脑出血（ICH）患者和223例短暂性脑缺血发作（TIA）患者的数据，这些患者在症状发作后6小时内入院。入院时进行12导联心电图检查，患者在住院的前12 - 24小时进行遥测。
60%的脑梗死患者、50%的ICH患者和44%的TIA患者观察到心电图异常。在多变量分析中，缺血性脑卒中患者3个月死亡率可通过以下因素预测：房颤，比值比（OR）2.0（95%可信区间[CI] 1.3 - 3.1）；房室传导阻滞，OR 1.9（95% CI 1.2 - 3.9）；ST段抬高，OR（2.8，95% CI 1.3 - 6.3）；ST段压低，OR 2.5（95% CI 1.5 - 4.3）；T波倒置，OR 2.7（95% CI 1.6 - 4.6）。这与卒中严重程度、卒中前残疾状况和年龄无关。在ICH患者中，窦性心动过速，OR 4.8（95% CI 1.7 - 14.0）；ST段压低，OR 5.2（95% CI 1.1 - 24.9）；T波倒置，5.2（95% CI 1.2 - 22.5）提示预后不良。在TIA患者中，这些变化均无统计学意义。在重度脑梗死或ICH患者中，入院后12小时内心率未下降，而轻度至中度卒中患者则有心率下降。在多变量检验中，心率增快预测3个月死亡率，OR 1.7（95% CI 1.02 - 2.7）。
急性卒中患者心电图异常常见，且可能预测3个月死亡率。
