卒中合并脑心综合征临床研究进展

姜嘟嘟; 金国华; 顾　勤; 王勤鹰; 余　敏; 韩　瑛; 宋浩明; 詹　青

doi:10.12022/jnnr.2017-0031

PDF(1727 KB)

神经病学与神经康复学杂志 ›› 2017, Vol. 13 ›› Issue (4) : 227-232. DOI: 10.12022/jnnr.2017-0031

综述

卒中合并脑心综合征临床研究进展

姜嘟嘟1，金国华1，顾　勤1，王勤鹰1，余　敏1，韩　瑛1，宋浩明2，詹　青1

作者信息 +

Advances in clinical studies on brain heart syndrome secondary to stroke

JIANG Dudu1, JIN Guohua1, GU Qin1, WANG Qinying1, YU Min1, HAN Ying1, SONG Haoming2, ZHAN Qing1

Author information +

文章历史 +

摘要

脑心综合征指卒中急性期引起的继发性心脏损害，表现为心脏功能紊乱及心电活动改变，导致病情加重，使治疗变得更为复杂，甚至出现矛盾，严重影响患者的预后。本文阐述了脑心综合征的观察指标、发病机制和治疗进展，特别指出心脏损伤的实验室检查指标和心电图异常与卒中分型及病变部位有关。同时指出治疗脑心综合征患者时，应首先治疗原发病，并在及时纠正心律失常、心肌缺血的同时，动态关注心电图和心脏损伤的实验室指标，做到实时有效地判定心脏损害，从而给予针对性的治疗和康复。

Abstract

Brain heart syndrome (BHS) refers to the secondary heart damage caused by acute-phase stroke, manifested as cardiac dysfunction and changes in cardiac electrical activity, leading to the aggravating conditions. The treatment of BHS has become more complex, or even contradictory, severely affects the prognosis of the patients. This paper discusses the advances in clinical examinations, pathogenesis and treatment of BHS, particularly pointing out that the laboratory results of heart damage and the electrocardiogram abnormalities are related to stroke type and the part of lesion in stroke. Meanwhile, it is pointed out that the primary disease should be treated first in the treatment of patients with BHS. The dynamic monitoring of electrocardiogram and laboratory tests for heart damage should be conducted while correcting arrhythmia and myocardial ischemia in time, which can determine the heart damage in real time and effectively, so as to give targeted treatment and rehabilitation.

导出引用

姜嘟嘟，金国华，顾　勤，王勤鹰，余　敏，韩　瑛，宋浩明，詹　青. 卒中合并脑心综合征临床研究进展[J]. 神经病学与神经康复学杂志. 2017, 13(4): 227-232 https://doi.org/10.12022/jnnr.2017-0031

JIANG Dudu, JIN Guohua, GU Qin, WANG Qinying, YU Min, HAN Ying, SONG Haoming, ZHAN Qing. Advances in clinical studies on brain heart syndrome secondary to stroke[J]. Journal of Neurology and Neurorehabilitation. 2017, 13(4): 227-232 https://doi.org/10.12022/jnnr.2017-0031

参考文献

[1] KWAKKEL G, WINTERS C, VAN WEGEN EE, et al. Effects of unilateral upper limb training in two distinct prognostic groups early after stroke: the EXPLICIT-stroke randomized clinical trial[J]. Neurorehabil Neural Repair, 2016, 30(9):804-816.
[2] BYER E, ASHMAN R, TOTH LA, et al. Electrocardiograms with large, upright T waves and long Q-T intervals[J]. Am Heart J, 1947, 33(6):796-806.
[3] 韩　瑛, 张颖琪, 吴晓华. 急性脑卒中后心电图及心肌酶谱和肌钙蛋白-T的变化[J]. 临床荟萃, 2003, 18(3):134-135.
[4] MIERZEWSKA-SCHMIDT M, GAWECKA A. Neurogenic stunned myocardium-do we consider this diagnosis in patients with acute central nervous system injury and acute heart failure?[J]. Anaesthesiol Intensive Ther, 2015, 47(2):175-180.
[5] Y-HASSAN S. Acute cardiac sympathetic disruption in the pathogenesis of the takotsubo syndrome: a systematic review of the literature to date[J]. Cardiovasc Revasc Med, 2014, 15(1):35-42.
[6] Y-HASSAN S. Myocarditis changes in the stunned myocardial segments in takotsubo syndrome: The role of the pattern of ventricular wall motion abnormality[J]. Int J Cardiol, 2015, 191:267-269.
[7] Y-HASSAN S. Too many cooks spoil the broth: the currently existing diagnostic criteria for Takotsubo syndrome[J]. Int J Cardiol, 2014, 173(3):568-570.
[8] SHOWKATHALI R, PATEL H, RAMOUTAR A, et al. Typical takotsubo cardiomyopathy in suspected ST elevation myocardial infarction patients admitted for primary percutaneous coronary intervention[J]. Eur J Intern Med, 2014, 25(2):132-136.
[9] RAVI Y, CAMPAGNA R, ROSAS PC, et al. Successful heart transplantation using a donor heart afflicted by takotsubo cardiomyopathy[J]. Proc (Bayl Univ Med Cent), 2016, 29(1):73-74.
[10] Y-HASSAN S. Myocarditis in takotsubo syndrome: may be a trigger and/or a feature[J]. Int J Cardiol, 2015, 199:154.
[11] ONO R, FALC?O LM. Takotsubo cardiomyopathy systematic review: Pathophysiologic process, clinical presentation and diagnostic approach to Takotsubo cardiomyopathy[J]. Int J Cardiol, 2016, 209:196-205.
[12] 李洋阳, 郎　野, 孟　然. 急性脑梗死脑心综合征发生的时间规律及其持续时间与临床预后的关系[J]. 中华老年心脑血管病杂志, 2016, 18(10):1061-1065.
[13] 陈兴泳, 张　旭, 雷惠新, 等. 急性脑梗死学N端－脑钠肽前体水平变化及临床意义[J]. 中国神经精神病学杂志, 2011, 37(7):423-424.
[14] 陈　娜, 杨　琴, 吴兆敏, 等. 脑出血急性期血浆N端脑钠肽前体浓度变化与预后的关系[J]. 中风与神经疾病, 2012, 29(1):35-37.
[15] 包广杰. hs-CRP、肌钙蛋白I和心肌酶在急性脑血管病中的临床应用[J]. 中国实用神经疾病杂志, 2011, 14(17):40, 83.
[16] 李宏治, 张宝成, 钟志越. 脑心综合征患者的心电图及心肌损伤标志物的变化[J]. 中国心脏起搏与心电生理杂志, 2011, 25(5):416-417.
[17] 臧召霞, 刘志强, 朴钟源, 等. 不同部位急性脑梗死早期cTnI、CK-MB改变的临床意义[J]. 黑龙江医药, 2012, 25(5):696-698.
[18] 乔　松, 王立羽, 高金霞. 老年急性脑血管病后脑心综合征发生相关因素：附243例分析[J]. 临床误诊误治, 2012, 25(8):63-65.
[19] 孙智善, 孟　然, 冯兴中, 等. 脑心综合征对急性缺血性脑卒中预后评价的临床意义[J]. 中华临床医师杂志：电子版, 2013, 7(11):4701-4703.
[20] 陈　辉, 王　冠. 脑心综合征对急性出血性卒中伴脑疝患者预后的影响[J]. 中国现代医药杂志, 2012, 14(9):95-96.
[21] 王利民, 朱　俊, 胡　艳, 等. 脑梗死患者86例动态心电图分析[J]. 中国医药科学, 2012, 2(9):28-29.
[22] MALIK AN, GROSS BA, ROSALIND LAI PM, et al. Neurogenic stress cardiomyopathy after aneurysmal subarachnoid hemorrhage[J]. World Neurosurg, 2015, 83(6):880-885.
[23] FINSTERER J, ST?LLBERGER C. Is autonomous neuropathy responsible for Takotsubo syndrome?[J]. Int J Cardiol, 2016, 209:339-340.
[24] 王晓莉, 张维文, 孟伟建, 等. rt-PA溶栓治疗合并脑心综合征的急性脑梗死47例[J]. 山东医药, 201555(47):60-61.
[25] REIKEN S, WEHRENS XH, VEST JA, et al. Beta-blockers restore calcium release channel function and improve cardiac muscle performance in human heart failure[J]. Circulation, 2003, 107(19):2459-2466.
[26] 祝艳芳, 杜业亮, 周　丽, 等. 普萘洛尔对急性脑梗死致脑心综合征大鼠血浆皮质醇（酮）的影响[J]. 潍坊医学院学报, 2016, (38)3:178-180.
[27] 张　玲. 前列地尔在急性脑梗死并发脑心综合征中的应用价值[J]. 中国实用神经疾病杂志, 2016, 19(17):9-11.
[28] 董　婷, 杨文明, 汪美霞, 等. 补阳还五汤治疗急性脑梗死并发脑心综合征（气虚血瘀证）90例临床观察[J]. 中国中医急症, 2011, 20(1):5-7.
[29] 金国华, 孟凡萍, 王丽晶, 等. 康复治疗对急性脑卒中合并心电图异常患者的影响[J]. 实用医学杂志, 2016, 32(20):3419-3421.