發(fā)布時(shí)間：2018-03-10 12:05

  本文選題：急性腦梗死　切入點(diǎn)：頸動(dòng)脈彩超　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:探討急性腦梗死患者牛津郡社區(qū)卒中研究(Oxfordshire Community Stroke Project,OCSP)分型與頸總動(dòng)脈、頸內(nèi)動(dòng)脈彩超及大腦中動(dòng)脈TCD檢查結(jié)果的相關(guān)性,通過檢測(cè)急性腦梗死OCSP分型患者的頸動(dòng)脈彩超及大腦中動(dòng)脈TCD檢查數(shù)據(jù),分析其相關(guān)性。探求頸動(dòng)脈超聲及大腦中動(dòng)脈TCD檢查對(duì)腦梗死OCSP分型患者的臨床意義,為臨床上急性腦梗死的診斷、治療和預(yù)后提供更為有效的信息。方法:選擇石家莊市第二醫(yī)院2012年3月-2015年3月住院治療的急性腦梗死患者125例,所有患者均符合臨床急性腦梗死診斷標(biāo)準(zhǔn),且由2位以上主任醫(yī)師確診均經(jīng)影像學(xué)證實(shí),患者病例資料完整。將125例研究對(duì)象按OCSP分型標(biāo)準(zhǔn)進(jìn)行分組,分為TACI(totalante-riorcirculationinfarct)組、PACI(partialante—riorcirculationinfarct)組、POCI(posteriorcirculationinfarct)組、LACI(1acunarinfarct)組,同時(shí)選取30例健康人群為對(duì)照組,5組研究對(duì)象在年齡、性別等方面不存在顯著性差異(P0.05),不具有統(tǒng)計(jì)學(xué)意義。采用頸動(dòng)脈超聲檢查測(cè)量5組研究對(duì)象頸動(dòng)脈的內(nèi)徑、內(nèi)-中膜厚度、斑塊大小,注意斑塊所在部位,回聲特點(diǎn)以及斑塊的形態(tài)、大小、性質(zhì),采用大腦中動(dòng)脈TCD收集4組研究對(duì)象患側(cè)、健康對(duì)照組同側(cè)大腦中動(dòng)脈,獲得血流方向、血流速度、頻譜形態(tài)及搏動(dòng)指數(shù)等參數(shù),并根據(jù)血管狹窄程度分級(jí)。所有數(shù)據(jù)通過SPSS12.0統(tǒng)計(jì)軟件包處理。一致性分析用Kappa值計(jì)算,等級(jí)相關(guān)分析用H檢驗(yàn),P0.05為有統(tǒng)計(jì)學(xué)意義。其中TACI組患者32例、PACI組31例、POCI組30例、LACI組32例。結(jié)果:1比較5組研究對(duì)象的性別、年齡、病程、基礎(chǔ)病、臨床癥狀等一般資料,TACI組患者男性16例,女性16例,平均年齡(51.27±2.89)歲,平均病程(3.28±0.27)年;PACI組患者男性19例,女性12例,平均年齡(50.17±2.42)歲,平均病程(3.10±1.19)年;POCK組患者男性18例,女性12例,平均年齡(52.18±2.20)歲,平均病程(2.97±1.28)年;LACI組患者男性19例,女性13例,平均年齡(55.29±2.14)歲,平均病程(3.06±0.82)年;對(duì)照組男性18例,女性12例,平均年齡(50.26±2.83)歲;5組研究對(duì)象在性別、年齡方面不存在顯著性差異(P0.05),不具有統(tǒng)計(jì)學(xué)意義,4組急性腦梗死患者在病程上不存在顯著性差異(P0.05),不具有統(tǒng)計(jì)學(xué)意義;TACI組高血壓19例,糖尿病7例,高血脂18例,心源性心臟病6例;PACI組高血壓17例,糖尿病5例,高血脂14例,心源性心臟病4例;POCI組高血壓21例,糖尿病7例,高血脂16例,心源性心臟病3例;LACI組高血壓22例,糖尿病3例,高血脂20例,心源性心臟病3例;對(duì)照組研究對(duì)象均無(wú)高血壓、糖尿病、高血脂等基礎(chǔ)病;少數(shù)急性腦梗死患者在發(fā)病前出現(xiàn)有頭暈、惡心、嘔吐等短暫性腦缺血癥狀,4組急性腦梗死患者臨床表現(xiàn)為不同程度的頸動(dòng)脈系統(tǒng)和(或)椎基底動(dòng)脈系統(tǒng)的癥狀、體征及口眼歪斜、半身不遂的癥狀,4組急性腦梗死患者在基礎(chǔ)病和臨床癥狀表現(xiàn)上存在顯著性差異(P0.05),具有統(tǒng)計(jì)學(xué)意義。2頸動(dòng)脈超聲檢測(cè)結(jié)果顯示,TACI組頸動(dòng)脈閉塞6例,頸動(dòng)脈狹窄70%2例,頸動(dòng)脈狹窄50%5例,檢出頸動(dòng)脈粥樣斑塊27例,共檢出84個(gè)斑塊,四個(gè)及以上斑塊16例,平均斑塊(3.01±1.25);PACI組頸動(dòng)脈閉塞3例,頸動(dòng)脈狹窄70%2例,頸動(dòng)脈狹窄50%4例,檢出頸動(dòng)脈粥樣斑塊25例,共檢出77個(gè)斑塊,四個(gè)及以上斑塊18例,平均斑塊(3.15±1.01);POCI組頸動(dòng)脈閉塞0例,頸動(dòng)脈狹窄70%1例,頸動(dòng)脈狹窄50%3例,檢出頸動(dòng)脈粥樣斑塊15例,共檢出28個(gè)斑塊,四個(gè)及以上斑塊5例,平均斑塊(1.95±1.35);LACI組頸動(dòng)脈閉塞0例,頸動(dòng)脈狹窄70%1例,頸動(dòng)脈狹窄50%2例,檢出頸動(dòng)脈粥樣斑塊20例,共檢出41個(gè)斑塊,四個(gè)及以上斑塊8例,平均斑塊(2.10±1.37)。4組急性腦梗死患者的頸動(dòng)脈狹窄、斑塊大小,注意斑塊所在部位,回聲特點(diǎn)以及斑塊的形態(tài)、性質(zhì)存在顯著性差異(P0.05),具有統(tǒng)計(jì)學(xué)意義。3分析5組研究對(duì)象大腦中動(dòng)脈TCD數(shù)據(jù)及血管狹窄程度分級(jí)情況,TACI組血流正常3例,輕度增高5例,中度增高8例,血流緩慢16例,大腦中動(dòng)脈血流峰速(59.14±7.28),舒張末速度(28.17±6.36),平均速度(40.02±2.17),搏動(dòng)指數(shù)(0.74±0.18)、阻力指數(shù)(0.52±0.08);PACI組血流正常1例,輕度增高14例,中度增高12例,血流緩慢4例,大腦中動(dòng)脈血流峰速(65.23±12.03),舒張末速度(30.26±9.20),平均速度(45.28±10.28),搏動(dòng)指數(shù)(0.78±0.13)、阻力指數(shù)(0.54±0.07);POCI組血流正常14例,輕度增高6例,中度增高8例,血流緩慢2例,大腦中動(dòng)脈血流峰速(95.16±15.27),舒張末速度(43.94±6.58),平均速度(64.39±10.82),搏動(dòng)指數(shù)(0.82±0.19)、阻力指數(shù)(0.54±0.03);LACI組血流正常6例,輕度增高13例,中度增高5例,血流緩慢8例,大腦中動(dòng)脈血流峰速(85.64±12.94),舒張末速度(37.72±9.20),平均速度(53.25±11.52),搏動(dòng)指數(shù)(0.89±0.15)、阻力指數(shù)(0.54±0.023);4組急性腦梗死患者患側(cè)大腦中動(dòng)脈,獲得血流方向、血流速度、搏動(dòng)指數(shù)等參數(shù)存在顯著性差異(P0.05),具有統(tǒng)計(jì)學(xué)意義,4組患者的阻力指數(shù)不存在顯著性差異(P0.05),不具有統(tǒng)計(jì)學(xué)意義。4 OCSP分型與頸動(dòng)脈彩超及大腦中動(dòng)脈TCD檢查相關(guān)性分析,TACI組患者大腦中動(dòng)脈病變14例,占43.75%,頸內(nèi)動(dòng)脈顱外段病變17例,占53.12%,椎動(dòng)脈顱內(nèi)段和基底動(dòng)脈病變4例,占12.50%,頸椎動(dòng)脈顱外段病變7例,占21.88%;PACI組大腦中動(dòng)脈病變11例,占35.48%,頸內(nèi)動(dòng)脈顱外段病變9例,占29.03%,椎動(dòng)脈顱內(nèi)段和基底動(dòng)脈病變3例,占9.68%,頸椎動(dòng)脈顱外段病變4例,占12.90%;POCI組大腦中動(dòng)脈病變9例,占30.00%,頸內(nèi)動(dòng)脈顱外段病變7例,占23.33%,椎動(dòng)脈顱內(nèi)段和基底動(dòng)脈病變13例,占43.33%,頸椎動(dòng)脈顱外段病變5例,占16.67%;LACI組大腦中動(dòng)脈病變8例,占25.00%,頸內(nèi)動(dòng)脈顱外段病變8例,占25.00%,椎動(dòng)脈顱內(nèi)段和基底動(dòng)脈病變5例,占15.63%,頸椎動(dòng)脈顱外段病變0例,占0%。4組急性腦梗死患者的頸動(dòng)脈及大腦中動(dòng)脈病變存在顯著性差異(P0.05),具有統(tǒng)計(jì)學(xué)意義。結(jié)論:1糖尿病、高血脂、高血壓、心源性心臟病是急性腦梗死的主要危險(xiǎn)因素,TACI型患者多由心源性栓塞引起,OCSP分型與患者腦梗死病變部位、閉塞血管、病灶大小具有較高的一致性。2 TACI型和PACI型的急性腦梗死患者頸動(dòng)脈血管閉塞和重度狹窄的發(fā)生率明顯高于POCI型和LACI型,急性腦梗死患者頸動(dòng)脈粥樣斑塊與OCSP分型存在相關(guān)性,TACI型和PACI型患者的不穩(wěn)定斑塊和多個(gè)斑塊率較高,可作為臨床診斷的參考依據(jù)。3 TACI型和PACI型的急性腦梗死患者都發(fā)生于大腦中動(dòng)脈血管病變,POCI型患者多為椎動(dòng)脈顱內(nèi)段和基底動(dòng)脈血管病變,LACI型患者則頸內(nèi)動(dòng)脈顱外段血管病變較為多見。4頸動(dòng)脈彩超及大腦中動(dòng)脈TCD檢查結(jié)果與急性腦梗死OCSP分型存在相關(guān)性及規(guī)律性�？煞从愁i動(dòng)脈及大腦中動(dòng)脈病變對(duì)于OCSP各分型的影響程度,為臨床工作提供有價(jià)值的參考。
[Abstract]:Objective: To investigate the Oxford County Community Stroke Patients with acute cerebral infarction (Oxfordshire Community Stroke Project, OCSP) and the types of common carotid artery, internal carotid artery artery TCD examination results between ultrasonography and brain, through the detection of acute cerebral infarction OCSP type patients with carotid artery vein ultrasonography and brain TCD examination data, analysis of its relevance. The clinical significance of ultrasonography and cerebral artery TCD explore carotid artery in cerebral infarction patients with type OCSP, for clinical diagnosis of acute cerebral infarction, treatment and prognosis to provide more effective information. Methods: 125 patients with acute cerebral infarction Second Hospital of Shijiazhuang city in March 2012 -2015 March hospitalized cases, all patients were consistent with clinical acute diagnostic criteria of cerebral infarction, and from more than 2 physician diagnosed and confirmed by imaging and clinical data of patients with complete. The 125 patients were divided according to OCSP The standard were divided into TACI group (totalante-riorcirculationinfarct), PACI (partialante - riorcirculationinfarct) group, POCI (posteriorcirculationinfarct) group, LACI (1acunarinfarct) group, and 30 cases of healthy people as control group, 5 groups in age, sex and no significant difference (P0.05), no statistically significant 5 groups of subjects. The measurement of carotid artery by ultrasonography of the carotid artery diameter, intima-media thickness, plaque size, note plaque location, echo characteristics and plaque morphology, size, nature, collected by TCD middle cerebral artery in 4 groups of subjects affected side and the healthy control group ipsilateral middle cerebral artery. Get the direction of blood flow, blood flow velocity, pulsatility index and morphological spectrum parameters, and according to the classification of stenosis degree. All the data by SPSS12.0 statistical software package. Using Kappa consistency analysis 鍊艱綆，

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