Neurology:急性脑卒中患者院前ECG的诊断价值如何?

2017-04-22 xing.T MedSci原创

在选定的卒中患者队列中,在现场的心电图记录可以检测到相关的心律失常。这些结果可以增加住院评估准确性,并且ECG应在急性脑卒中的院前急救中予以考虑。

近日,神经病学领域权威取杂志Neurology上发表了一篇研究文章,研究人员旨在探讨疑似脑卒中病例接受急救医疗服务提供的院前心电图监测的诊断价值。

在为期12个月的研究阶段,研究人员前瞻性地纳入了来研究者所在医疗机构连续就诊的急性脑卒中住院患者,这些脑卒中患者通过急救医疗服务入院,并且在院前进行过心电图检查。研究人员评估了参与者院前心电图的结果,并与入院时的常规12导联心电图以及卒中单元中的连续心电图监测进行了比较。

总体而言,259例有院前心电图记录的患者被纳入研究(90.3%为缺血性卒中患者,9.7%为脑出血患者)。在25.1%的患者中检测到心房颤动,在5.4%的患者中检测到二度或更高的房室传导阻滞,5%的患者存在明显的ST段抬高,9.7%的患者存在室性心律失常。在18例患者中,新发房颤诊断以及脑卒中的二级预防临床后果的直接评价是通过院前ECG记录来判断的。在2例患者中,房颤发作仅在院前期,而在入院时ECG或在随后的脑卒中单元监测时没有检测到。126例患者(48.6%)在院前ECG中有相关的异常,16.7%的患者在去医院的途中接受了药物抗心律失常治疗,6.4%的患者在入院后前24小时内被转移到心脏病中心。

在选定的卒中患者队列中,在现场的心电图记录可以检测到相关的心律失常。这些结果可以增加住院评估准确性,并且ECG应在急性脑卒中的院前急救中予以考虑。

原始出处:

Tobias Bobinger,et al. Diagnostic value of prehospital ECG in acute stroke patients. Neurology. 2017.http://www.neurology.org/content/early/2017/04/20/WNL.0000000000003940.abstract

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replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/NUyjXTCJjo5F5JiaKt8tLwAUUH6ejxhvAsyiaic6HXW0KBxzqaPJQO1KHKuxoBl9KFWFhTicx7Y55WmfwziabRoDRbxicybUWTcOUw/0, createdBy=21cc2055669, createdName=kun111, createdTime=Wed May 03 06:57:55 CST 2017, time=2017-05-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=190957, encodeId=abca19095e9f, content=实用的文章学习并分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=47, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20200816/e4675a86ea694f12b82202b320dc2654/12f6b900498349e994ce8f516a584d6a.jpg, createdBy=09431951290, createdName=大爰, createdTime=Thu Apr 27 06:19:26 CST 2017, time=2017-04-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1366947, encodeId=2f99136694e10, content=<a href='/topic/show?id=d0e0524218b' target=_blank style='color:#2F92EE;'>#急性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52421, encryptionId=d0e0524218b, topicName=急性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=856b247, createdName=songbq, createdTime=Mon Apr 24 07:05:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456621, encodeId=b346145662156, content=<a href='/topic/show?id=b636648639' target=_blank style='color:#2F92EE;'>#ECG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6486, encryptionId=b636648639, topicName=ECG)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81775776472, createdName=yaanren, createdTime=Mon Apr 24 07:05:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189982, encodeId=a859189982be, content=国外的发病到急诊干预时间短,所以ECG意义重大, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Sun Apr 23 21:29:36 CST 2017, time=2017-04-23, status=1, ipAttribution=)]
    2018-02-03 yinhl1978
  5. 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  6. 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href='/topic/show?id=d0e0524218b' target=_blank style='color:#2F92EE;'>#急性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52421, encryptionId=d0e0524218b, topicName=急性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=856b247, createdName=songbq, createdTime=Mon Apr 24 07:05:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456621, encodeId=b346145662156, content=<a href='/topic/show?id=b636648639' target=_blank style='color:#2F92EE;'>#ECG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6486, encryptionId=b636648639, topicName=ECG)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81775776472, createdName=yaanren, createdTime=Mon Apr 24 07:05:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189982, encodeId=a859189982be, content=国外的发病到急诊干预时间短,所以ECG意义重大, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Sun Apr 23 21:29:36 CST 2017, time=2017-04-23, status=1, ipAttribution=)]
    2017-05-03 kun111

    阵发性房颤7天内房颤

    0

  7. 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href='/topic/show?id=d0e0524218b' target=_blank style='color:#2F92EE;'>#急性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52421, encryptionId=d0e0524218b, topicName=急性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=856b247, createdName=songbq, createdTime=Mon Apr 24 07:05:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456621, encodeId=b346145662156, content=<a href='/topic/show?id=b636648639' target=_blank style='color:#2F92EE;'>#ECG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6486, encryptionId=b636648639, topicName=ECG)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81775776472, createdName=yaanren, createdTime=Mon Apr 24 07:05:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189982, encodeId=a859189982be, content=国外的发病到急诊干预时间短,所以ECG意义重大, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Sun Apr 23 21:29:36 CST 2017, time=2017-04-23, status=1, ipAttribution=)]
    2017-04-27 大爰

    实用的文章学习并分享!

    0

  8. 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href='/topic/show?id=d0e0524218b' target=_blank style='color:#2F92EE;'>#急性脑卒中#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=52421, encryptionId=d0e0524218b, topicName=急性脑卒中)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=856b247, createdName=songbq, createdTime=Mon Apr 24 07:05:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1456621, encodeId=b346145662156, content=<a href='/topic/show?id=b636648639' target=_blank style='color:#2F92EE;'>#ECG#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=6486, encryptionId=b636648639, topicName=ECG)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=81775776472, createdName=yaanren, createdTime=Mon Apr 24 07:05:00 CST 2017, time=2017-04-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189982, encodeId=a859189982be, content=国外的发病到急诊干预时间短,所以ECG意义重大, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Sun Apr 23 21:29:36 CST 2017, time=2017-04-23, status=1, ipAttribution=)]
  9. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189982, encodeId=a859189982be, content=国外的发病到急诊干预时间短,所以ECG意义重大, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Sun Apr 23 21:29:36 CST 2017, time=2017-04-23, status=1, ipAttribution=)]
    2017-04-24 yaanren
  10. 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ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=189982, encodeId=a859189982be, content=国外的发病到急诊干预时间短,所以ECG意义重大, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLCclExeQ6LOGMD4dTsia4Ty4HtZCxRmG5vO5XIKfKX3a3vusfhHSej4Iib517vmhFW7RQgh7bpDp1yw/0, createdBy=50951609779, createdName=baihao215, createdTime=Sun Apr 23 21:29:36 CST 2017, time=2017-04-23, status=1, ipAttribution=)]
    2017-04-23 baihao215

    国外的发病到急诊干预时间短,所以ECG意义重大

    0

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Stroke:CT血管造影在急性脑卒中患者评价中的安全性较好

长期以来非增强型头部计算机断层扫描(NCHCT)一直是急性卒中成像的护理标准。新的指南建议使用先进的血管影以确定符合血管内治疗条件的患者,并且更新了在紧急设置中无实验室确认的肾功能患者的安全性问题。在急性卒中评估过程中,对于关注肾安全性和及时治疗的合时性,研究人员比较了CT血管造影(CTA) vs 单纯NCHCT的结果。在2013年12月至2014年9月期间,研究人员回顾了急性卒中干预小组的所有急

盘点:近期急性脑卒中研究进展汇总

【1】Neurology: 急性脑卒中患者鼻饲管与肺炎、临床结局的关系近日,神经病学领域权威杂志《neurology》上发表来自英国伦敦国王学院附属医院临床和基础神经科学系Lalit Kalra博士及其团队的文章,旨在明确急性脑卒中患者鼻饲管、肺炎及其临床结局的关系。该研究是一项多中心的随机对照试验,纳入了从2008年4月21日至2014年5月17日期间住院1217例在症状发作48小时内预防性

Hypertension:卒中前接受降压治疗的患者发生急性脑卒中是继续还是暂停降压治疗?

因此,在卒中前接受抗高血压药物治疗的患者中,卒中后的最初几个小时或几天内没有必要紧急进行原有的降压治疗,除非存在有指征的其他合并症。

汇总:近期急性脑卒中精华研究一览

急性脑卒中常伴有明显的植物神经症状,大多数是由于病变直接、间接引起的丘脑下部损害所致,可作为重度脑卒中的临床诊断及判断预后的参考指标。梅斯医学小编为您盘点近期相关研究进展。【1】ISC 2017:急性卒中患者采取什么样的姿势最佳?坐着or平躺 目前急性缺血性卒中或脑出血患者采取什么样的姿势最佳尚不确定。缺血性卒中患者平躺的潜在获益(增加侧枝循环血流)可能会被吸入性肺炎的风险增加所抵消

Stroke:脓毒症住院患者发生急性脑卒中风险高吗?

脓毒症后脑卒中发生风险较高,并且风险持续长达一年。年轻的脓毒症患者在脓毒症后脑卒中发生风险明显升高。

Neurology:院前心电图在急性脑卒中患者的诊断中的价值

中风患者入院前心电图检测发现患者发生心律失常比例较大,进行中风治疗时应充分考虑患者的心脏情况