高龄房颤伴急性脑梗死56例临床分析

摘要

目的 了解高龄房颤伴急性脑梗死患者的临床特征.方法 回顾性分析2013年1月至2015年6月入住我院的56例高龄房颤伴急性脑梗死患者的临床诊治资料.结果 56例患者中,大面积脑梗死13例(23.2%),小面积脑梗死37例(66.1%),腔隙性脑梗死仅6例(10.7%).38例(67.9%)合并有高血压病,28例(50.0%)合并有冠心病,20例(35.7%)合并有糖尿病,10例(17.9%)合并老年退行性瓣膜病变;1例(1.8%)以头晕起病;46例(82.1%)以肢体偏瘫起病,其中伴有言语障碍或吞咽呛咳40例,9例(16.1%)以突发意识障碍起病.有26例(46.4%)合并了肺部感染;预后方面,仅1例(1.8%)患者完全恢复,8例(14.3%)出现梗塞后出血转化,7例(12.5%)因病情危重自动放弃出院.40例(71.4%)患者的肢体及言语障碍无明显恢复.结论 高龄房颤伴急性脑梗死患者合并症多,肺炎并发症比率高,预后极差.%Objective To investigate the clinical characteristics of elderly patients with atrial fibrillation and acute cerebral infarction. Methods The clinical data of 56 elderly patients with atrial fibrillation and acute cerebral in-farction in our hospital from January 2013 to June 2015 were retrospectively analyzed. Results Among the 56 patients, there were 13 patients of large area cerebral infarction (23.2%), 37 patients of small area cerebral infarction (66.1%), 6 patients of lacunar cerebral infarction (10.7%). 38 patients of hypertension (67.9%), 28 patients of coronary heart dis-ease (50.0%), 20 patients of diabetes (35.7%), and 10 patients complicating senile degenerative valvular disease (17.9%). In ways of onset, one patient (1.8%) had dizziness, and 46 patients (82.1%) had limb paralysis, in which there were 40 cases accompanied by speech disorder or swallowing cough and 9 patients (16.1%) with sudden onset of disturbance of consciousness. There were 26 patients (46.4%) complicating pulmonary infection. As for prognosis, only 1 patient (1.8%) recovered completely;Eight patients (14.3%) appeared hemorrhagic transformation, and 7 patients (12.5%) dis-charged actively due to the poor disease condition;Forty patients (71.4%) had no obvious recovery of limb paralysis and speech disorders. Conclusion Elderly patients with atrial fibrillation and acute cerebral infarction often have multiple complications, with high incidence of pneumonia and poor prognosis.