天津医药

天津医药 ›› 2017, Vol. 45 ›› Issue (11): 1202-1205.doi: 10.11958/20170749

• 临床研究 • 上一篇    下一篇

心电图改变和自发性脑出血患者急性期预后的相关性研究

朱玮，杨鹏   

  1. 苏州大学附属第一医院
  • 收稿日期:2017-06-28 修回日期:2017-09-12 出版日期:2017-11-15 发布日期:2017-11-15
  • 通讯作者: 杨鹏 E-mail:yangpeng@suda.edu.cn
  • 基金资助:
    苏州市科技计划项目（SYS201616）

Study on the correlation between prognosis and ECG changes in patients with acute spontaneous intracerebral hemorrhage#br#

ZHU Wei,YANG Peng   

  1. The First Affiliated Hospital of Suzhou University
  • Received:2017-06-28 Revised:2017-09-12 Published:2017-11-15 Online:2017-11-15
  • Contact: YANG Peng E-mail:yangpeng@suda.edu.cn

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摘要： 目的 探讨自发性脑出血患者心电图改变与其急性期预后的关系。方法 分析 183 例自发性脑出血患者的出血部位和出血量与心电图改变的关系，并且进行自发性脑出血急性期预后以及异常心电图的 Logistic 回归分析，分析心电图改变与其急性期预后的关系。结果 183 例自发性脑出血患者的出血部位位于脑干 44 例、丘脑 21例、基底节 42 例、小脑 76 例，其心电图异常者分别有 35 例（79.5%）、16 例（76.2%）、21 例（50.0%）、31 例（40.8%），不同出血部位的心电图异常者比例差异有统计学意义（χ2=21.638，P＜0.05），病灶位于中线结构处，心电图异常者多。少量出血（幕上）组（出血量≤10 mL）20 例，中等量出血（幕上）组（10 mL＜出血量为＜30 mL）25 例，大量出血组（出血量≥30 mL）18 例，各组心电图异常者分别有 7 例（35.0%）、18 例（72.0%）、16 例（88.9%），3 组心电图异常者比例比较差异有统计学意义（χ2=12.979，P＜0.05），中等量以及大量出血组心电图异常者较少量出血组多（χ2分别为 6.161 和11.515，P＜0.05），而中等量以及大量出血组两者之间差异无统计学意义（χ2=1.804，P＞0.05）。死亡组 69 例中心电图异常者 51 例（73.9%），存活组 114 例中心电图异常者为 52 例（45.6%），2 组间差异有统计学意义（χ2=13.990，P＜0.05）。通过自发性脑出血急性期预后以及异常心电图的 Logistic 回归分析发现，ST-T 改变、U 波异常和长 QT 间期是自发性脑出血急性期死亡的危险因素。结论 积极治疗脑部原发疾病的同时应密切监测心电图的变化并及时处理，防止急性期死亡的发生。

关键词: 脑出血, 心电描记术, 预后, 自发性脑出血, 异常心电图

Abstract: Objective To study the relationship between changes of electrocardiogram (ECG) and the prognosis of patients with acute spontaneous intracerebral hemorrhage. Methods The relationship between ECG changes and location data of intracerebral hemorrhage in 183 patients was analyzed. The prognosis of spontaneous intracerebral hemorrhage in acute stage and the abnormal ECG were analyzed by Logistic regression analysis. Results In 183 patients, there were 44 cases of brainstem hemorrhage, 21 cases of thalamic hemorrhage, 42 cases of basal ganglia hemorrhage and 76 cases of cerebellar hemorrhage. In these patients, there were abnormal ECG findings in 35 cases (79.5%), 16 cases (76.2%), 21 cases (50.0%) and 31 cases (40.8%). There were significant differences in the proportions of patients with ECG abnormalities in different bleeding sites (χ2=21.638，P＜0.05). Abnormal ECG was more common when intracerebral hemorrhage was located at the midline structures. According to the hematoma volumes, there were 20 cases with hematoma volumes ≤ 10 mL(35.0%), 25 cases with hematoma volumes between 10 mL - 30 mL (72.0%) and 18 cases with hematoma volumes ≥ 30 mL(88.9%). There were 7 cases with abnormal ECG, 18 cases with abnormal ECG and 16 cases with abnormal ECG in these three groups of patients. There were significant differences in the proportions of patients with ECG abnormalities between three groups (χ2=12.979，P＜0.05). There were more patients with abnormal ECG in hematoma volumes between 10 mL - 30 mL group and hematoma volumes ≥ 30 mL group than those of patients with hematoma volumes ≤ 10 mL group (χ2=6.161 and 11.515, P＜0.05). There was no significant difference in patients with ECG abnormalities between hematoma volumes of 10 mL - 30 mL group and hematoma volumes ≥ 30 mL group (χ2=1.804，P＞0.05). There were 51 cases with abnormal ECG in 69 cases of death group (73.9%). There were 52 cases with abnormal ECG in 114 cases of survival group (45.6%). There was significant difference between the two groups (χ2=13.990，P＜0.05). Logistic regression analysis revealed that the ST-T change, U-wave abnormality and long QT interval were risk factors for death in the acute phase of spontaneous intracerebral hemorrhage. Conclusion While actively treating primary brain diseases, we should closely monitor changes of ECG and deal with them in time so as to prevent the death of patients with acute phase of spontaneous intracerebral hemorrhage.

Key words: cerebral hemorrhage, electrocardiography, prognosis, spontaneous intracerebral hemorrhage, abnormal ECG

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