房颤患者脑卒中类型及发病机制分析

非瓣膜性房颤患者脑卒中类型及发病机制分析

【摘要】

目的回顾性分析我院心房颤动脑卒中患者的脑梗死类型及相关发病因素，以探讨非瓣膜性房颤患者发生脑卒中可能存在的发病机制和意义。

方法对2005年9月至2007年9月在我院住院和门诊的房颤并发脑卒中患者进行调查，观察分析瓣膜性和非瓣膜性心房颤动合并脑卒中患者的梗死类型和相关发病因素的区别，筛选非瓣膜性心房颤动发生脑卒中的可能病因和机制。

结果瓣膜性房颤和非瓣膜性房颤脑卒中患者有相同的危险因素：心衰、高纤维蛋白原，也有不同的危险因素：瓣膜性房颤脑卒中与过快的心室率（即：频速型房颤）关系密切，非瓣膜性房颤脑卒中则与高血压、动脉硬化、高脂血症、高血糖的关系密切；非瓣膜性房颤与瓣膜性房颤发生脑卒中的类型不同，瓣膜性房颤发生大动脉栓塞的可能性大，而非瓣膜性房颤发生脑卒中的类型多种多样，包括大动脉栓塞、皮层支梗死、分水岭梗死及腔隙性梗死，特别以分水岭梗死为多。结论非瓣膜性心房颤动病人可能发生不同类型的脑梗死，发病机制除了心源性栓子脱落造成脑栓塞外，还包括其它不同机制引起的梗死，包括血流动力学改变、动脉粥样硬化斑块形成或脱落、血液流变学改变等，而分水岭梗死的多发则提示血流动力学的改变应为其发生脑梗死的可能病因和重要机制；同时，非瓣膜性房颤脑卒中患者合并高血压、动脉硬化、高脂血症、高血糖的机率大，因而，对卒中的预防除了强调抗凝之外应包括：较好地控制心室率、控制血压、血糖、血脂水平，只有从综合防治的角度出发，改善血流动力学状态，控制血液流变学因素，逆转动脉硬化程度等，才能起到防治中风的目的。

【关键词】非瓣膜性房颤卒中发病机制

Stroke categories of non valvular atrial fibrillation and

analyses of their pathogenesis

【Abstract 】

Objective To probe into the possible pathogenesis and its significance of cerebrovascular disorders of the patients with non-valvular atrial fibrillation (abbreviated to non-VAF) by restropectively analyzing the categories of cerebral infarct and their related pathogenic factors of the non-VAF patients from my hospital. Methods I have screened out the possible etiogenic mechanism of cerbrovascular disorders of the non-VAF patients through investigation into some inpatients and outpatients from my hospital between 2005 and 2007 with auricular fibrillation complicated by cerebrovascular disorders,and by carefully observing and analyzing of the distinctions of the categories of cerebral infarct and their related pathogenesis between stroke patients with valvular auricular fibrillation (abbreviated to VAF) and those with non-VAF.

Results Stroke patients with non-VAF and those with VAF share the same hazard factors : heart failure, high fibrinogen; also they have different risk factors:

VAF-related cerebrovascular disorders are tightly connected with fast ventricular rhythm, i.e. frequent auricular fibrillation, however, non-VAF-related cerebrovascular disorders are closely connected with hypertension, arteriosclerosis, hyperhipemia and hyperglycemia. Stroke patients with non-VAF and those with VAF fall into different categories. VAF is more likely to occur with aortic embolism, while

non-VAF may be accompanied by a wide variety of cerebrovascul-ar

disorders,including aortic embolism, cortical branch infarct ,watershed infarct and lacunar infarct and so on ,especially of watershed infarct.

Conclusion Non-VAF patients may suffer from a variety of cerebral infarction, whose pathogenesis involves not only cerebral thrombosis caused by scaling-off cardiogenic emboli, but also embolism triggered by some other mechanisms, including hemodynamic changes, atherosclerotic plaque formations or scales-off,