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目的通过临床资料的回顾性分析探讨起搏器植入术后短暂性脑缺血及卒中的危险因素。方法收集本院从2011年3月至2014年6月行起搏器植入术患者,经心脏彩超检查分为卵圆孔未闭组(PFO组)与非卵圆孔未闭组(非PFO组),观察术后1周内两组患者短暂性脑缺血及缺血性脑卒中事件发生例数,并观察两组患者心房颤动(简称房颤)发作记录情况。结果共入选386例,其中PFO组66例,非PFO组320例。术后共发生脑缺血事件8例,其中短暂性脑缺血事件6例,缺血性脑卒中事件2例。PFO组患者短暂性脑缺血及缺血性脑卒中事件发生率明显高于非PFO组(7/66vs 1/320,P=0.003)。两组患者围手术期发生相关事件且有房颤记录者仅2例,PFO组内有房颤记录者与无房颤记录者发生短暂性脑缺血及缺血性脑卒中事件比较无差异(1/7vs 6/59,P=0.562)。结论除房颤心律外,卵圆孔未闭可能是起搏器植入术后发生短暂性脑缺血及缺血性脑卒中重要危险因素,术前应行心脏彩超检查明确。
Objective To investigate the risk factors of transient cerebral ischemia and stroke after implantation of pacemaker by retrospective analysis of clinical data. Methods Patients undergoing pacemaker implantation in our hospital from March 2011 to June 2014 were divided into patients with patent foramen ovale (PFO group) and non-patent foramen ovale (PFO group) Group). The number of cases of transient ischemic attack and ischemic stroke in the two groups were observed within 1 week after operation, and the seizure records of atrial fibrillation (AF) in both groups were observed. Results A total of 386 patients were enrolled, including 66 PFO patients and 320 non-PFO patients. Postoperative ischemic events in 8 cases, including transient ischemic events in 6 cases, ischemic stroke in 2 cases. The incidence of transient ischemic and ischemic stroke in PFO patients was significantly higher than that in non-PFO patients (7/66 vs 1/320, P = 0.003). There was no difference in transient ischemic attack and ischemic stroke among patients with atrial fibrillation and those without atrial fibrillation in PFO group (P> 0.05) 1/7 vs 6/59, P = 0.562). Conclusion In addition to atrial fibrillation heartbeat, foramen ovale may be an important risk factor of transient ischemic stroke and ischemic stroke after implantation of pacemaker. The examination of cardiac ultrasonography should be performed before operation.