Objective To investigate the impact of atrial fibrillation on neurological function and prognosis in acute ischemic stroke patients treated by intravenous thrombolytic therapy.Methods A total of 106 patients with acute ischemic stroke were selected in the Third People's Hospital of Dalian from March 2015 to March 2016,and they were divided into A group (merged with atrial fibrillation,n =51) and B group (did not merge with atrial fibrillation,n =55) according to ECG examination results;according to duration between attack and venous thrombolytic therapy,patients of A group were divided into A1 group (with duration between attack and venous thrombolytic therapy less than 3.0 hours,n =24) and A2 group (with duration between attack and venous thrombolytic therapy equal or over 3.0 hours but equal or less than 4.5 hours,n =27),patients of B group were divided into B1 group (with duration between attack and venous thrombolytic therapy less than 3.0 hours,n =26) and B2 group (with duration between attack and venous thrombolytic therapy equal or over 3.0 hours but equal or less than 4.5 hours,n =29).All of the 106 patients received rt-PA for intravenous thrombolytic therapy.NIHSS score before treatment,after 24 hours,7 days and 14 days of treatment,mRS score after 3 months of follow-up,and incidence of complications during the treatment were compared between A group and B group,between A1 group and B1 group,between A2 group and B2 group.Results No statistically significant differences of NIHSS score was found between A group and B group before treatment,after 24 hours,7 days or 14 days of treatment (P ＞ 0.05).After 3 months of follow-up,mRS score of A group was statistically significantly higher than that of B group (P ＜0.05).Incidence of hemorrhagic transformation A group was statistically significantly higher than that of B group during the treatment (P ＜ 0.05),while no statistically significant differences of incidence of symptomatic intracranial hemorrhage or fatality rate was found between A group and B group (P ＞ 0.05).No statistically significant differences of NIHSS score was found between A1 group and B1 group before treatment,after 24 hours,7 days or 14 days of treatment (P ＞0.05).mRS score of A1 group was statistically significantly higher than that of B1 group after 3 months of follow-up (P ＜ 0.05).No statistically significant differences of incidence of hemorrhagic transformation or symptomatic intracranial hemorrhage,or fatality rate was found between A1 group and B1 group during the treatment (P ＞ 0.05).No statistically significant differences of NIHSS score was found between A2 group and B2 group before treatment,after 24 hours,7 days or 14 days of treatment (P ＞ 0.05).mRS score of A2 group was statistically significantly higher than that of B2 group after 3 months of follow-up (P ＜ 0.05).Incidence of hemorrhagic transformation A2 group was statistically significantly higher than that of B2 group during the treatment (P ＜ 0.05),while no statistically significant differences of incidence of symptomatic intracranial hemorrhage or fatality rate was found between A2 group and B2 group (P ＞ 0.05).Conclusion Atrial fibrillation has no obvious impact on neurological function in acute ischemic stroke patients treated by intravenous thrombolytic therapy,atrial fibrillation has impact on prognosis in acute ischemic stroke patients treated by intravenous thrombolytic therapy,and intravenous thrombolytic therapy within 3.0 hours after attack would not increase the risk of hemorrhagic transformation in acute ischemic stroke patients merged with atrial fibrillation,but intravenous thrombolytic therapy within 3.0 to 4.5 hours after attack may increase the risk of hemorrhagic transformation.%目的 探讨心房颤动对急性缺血性脑卒中(AIS)患者静脉溶栓治疗后神经功能和预后的影响.方法 选取2015年3月—2016年3月大连市第三人民医院收治的AIS患者106例,根据心电图检查结果分为A组(合并心房颤动,n=51)与B组(未合并心房颤动,n=55);根据发病至静脉溶栓治疗时间将A组患者分为A1组(发病至静脉溶栓治疗时间＜3.0h,n=24)与A2组(发病至静脉溶栓治疗时间介于3.0 ～4.5 h,n=27),将B组患者分为B1组(发病至静脉溶栓治疗时间＜3.0h,n=26)与B2组(发病至静脉溶栓治疗时间介于3.0～4.5 h,n=29).所有患者予以重组组织型纤溶酶原激活剂(rt-PA)静脉溶栓治疗.比较A组与B组、A1组与B1组、A2组与B2组患者治疗前和治疗后24h、7d、14d美国国立卫生研究院卒中量表(NIHSS)评分,随访3个月改良Rankin量表(mRS)评分,治疗期间并发症发生情况.结果 治疗前和治疗后24 h、7d、14dA组与B组患者NIHSS评分比较,差异无统计学意义(P＞0.05);随访3个月A组患者mRS评分高于B组(P＜0.05);治疗期间A组患者出血性转化发生率高于B组(P＜0.05),而A组与B组患者症状性颅内出血发生率和病死率比较,差异无统计学意义(P＞0.05).治疗前和治疗后24h、7d、14 d A1组与B1组患者NIHSS评分比较,差异无统计学意义(P＞0.05);随方3个月A1组患者mRS评分高于B1组(P＜0.05);治疗期间A1组与B1组患者出血性转化、症状性颅内出血发生率和病死率比较,差异无统计学意义(P＞0.05).治疗前和治疗后24h、7d、14dA2组与B2组患者NIHSS评分比较,差异无统计学意义(P＞0.05);随访3个月A2组患者mRS评分高于B2组(P＜0.05);治疗期间A2组患者出血性转化发生率高于B2组(P＜0.05),而A2组与B2组患者症状性颅内出血发生率和病死率比较,差异无统计学意义(P＞0.05).结论 心房颤动对AI5患者静脉溶栓治疗后神经功能无明显影响,但对远期预后有影响,且AIS合并心房颤动患者发病3.0h内行静脉溶栓治疗并未增加出血性转化发生风险,而发病3.0～4.5 h行静脉溶栓治疗则出血性转化发生风险增加.
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