本文選題：腦梗死　切入點：出血性轉(zhuǎn)化　出處：《蘭州大學(xué)》2014年碩士論文

【摘要】：目的 觀察72例腦梗死患者發(fā)生出血性轉(zhuǎn)化(HT)的時間,總結(jié)其發(fā)病時間規(guī)律性,為臨床及時調(diào)整治療方案提供依據(jù)；對72例HT患者在MRI上的表現(xiàn)特點進行歸納、總結(jié),提出新的MRI分型。 材料和方法 1.本研究搜集HT病例72例(均未給予溶栓治療),男性42人,女性30人,年齡30-82歲。其中栓塞性腦梗死患者22人,血栓形成性腦梗死50人。栓塞性、血栓形成性腦梗死的診斷由臨床醫(yī)師通過病史、心電圖、心臟彩超、頸動脈彩超及經(jīng)顱多普勒等檢查作出。所有CT和MRI片由兩名從事多年影像診斷的醫(yī)師進行判斷。 2.通過影像學(xué)資料及臨床病程記錄計算出栓塞性和血栓形成性腦梗死患者發(fā)生HT的時間,具體算法為：監(jiān)測到出血的時間點減去出現(xiàn)腦梗死臨床癥狀的時間,分別計算出栓塞性和血栓形成性腦梗死患者在發(fā)病1-3天、4-7天和7天以上發(fā)生HT的人數(shù),采用SPSS17.0軟件包對所測數(shù)據(jù)進行統(tǒng)計分析,P0.05認為有統(tǒng)計學(xué)意義。頭顱CT平掃圖像由德國西門子公司Siemens Sensation64層螺旋CT機進行掃描,MRI平掃及DWI圖由美國GE公司產(chǎn)singa CV/I1.5T超導(dǎo)型MRI掃描儀掃描,結(jié)合臨床及影像學(xué)檢查作出HT診斷。通過觀察所有病例MRI平掃及DWI圖,記錄不同發(fā)生部位、不同出血形態(tài)以及不同發(fā)生部位的出血形態(tài)的病例數(shù),計算出其相應(yīng)的發(fā)生率。最后,結(jié)合出血部位、出血形態(tài)、發(fā)生率提出新的MRI分型。 結(jié)果 腦梗死HT在發(fā)病后1周以內(nèi)發(fā)生者67例,占93.1%,大于1周者5例,占6.9%。栓塞性腦梗死HT的發(fā)生時間早于血栓形成性腦梗死,前者為第1-3天,后者為第4-7天,兩者間差異有統(tǒng)計學(xué)意義(P=0.017)。 HT僅發(fā)生于幕上最多(占84.7%),幕下次之(占12.5%),幕上幕下同時發(fā)生最少(占2.8%)。出血形態(tài)上,斑片樣、斑點樣最多見(55.3%),腦回樣、線樣出血次之(39.4%),血腫形成型最少(5.3%)。其中腦回樣、線樣出血最多見于腦葉(占89.2%),斑片樣、斑點樣出血最多見于基底節(jié)區(qū)(占48.2%)。 結(jié)論 栓塞性和血栓形成性腦梗死發(fā)生HT的高峰時間不同,栓塞性腦梗死HT的發(fā)生時間早于血栓形成性腦梗死。本研究提出腦梗死HT新的MRI分型：Ⅰ型：幕上非血腫型；Ⅱ型：幕下非血腫型；Ⅲ型：血腫形成型；Ⅳ型：混合(幕上及幕下)非血腫型。
[Abstract]:PurposeTo observe the time of hemorrhagic transformation (HTT) in 72 patients with cerebral infarction, to summarize the regularity of its onset time, to provide the basis for clinical timely adjustment of treatment scheme, to sum up the characteristics of 72 patients with HT on MRI.A new MRI typing was proposed.Materials and methods1.This study collected 72 cases of HT (all without thrombolytic therapy, 42 males and 30 females, aged 30-82 years).Among them, 22 patients with embolic cerebral infarction and 50 patients with thrombotic cerebral infarction.The diagnosis of embolic and thrombotic cerebral infarction was made by clinicians through history, electrocardiogram, echocardiography, carotid ultrasound and transcranial Doppler.All CT and MRI films were judged by two physicians who had been diagnosed for many years.2.The time of occurrence of HT in patients with embolic and thrombotic cerebral infarction was calculated by imaging data and clinical course records. The specific algorithm was: monitoring the time point of hemorrhage minus the time of occurrence of clinical symptoms of cerebral infarction.The number of patients with embolic and thrombotic cerebral infarction who developed HT on 1-3 days 4-7 days and more than 7 days were calculated respectively. The data were statistically analyzed by SPSS17.0 software package (P0.05).Cranial CT plain scan was performed by Siemens Sensation64 spiral CT machine of Siemens Company in Germany and DWI was scanned by singa CV/I1.5T superconducting MRI scanner produced by GE Company in USA. HT was diagnosed by clinical and imaging examination.By observing the MRI plain scan and DWI images of all cases, we recorded the number of cases with different occurrence sites, different haemorrhage patterns and different occurrence sites, and calculated the corresponding incidence rate.Finally, a new MRI classification was proposed based on the location, morphology and incidence of bleeding.ResultThere were 67 cases of HT within 1 week after the onset of cerebral infarction, accounting for 93.1%, and 5 cases more than 1 week, accounting for 6.9%.The time of occurrence of HT in embolic cerebral infarction was earlier than that in thrombotic cerebral infarction (1-3 days in the former and 4-7 days in the latter). The difference between the two groups was statistically significant.HT only occurred on the curtain (84.7%), the next one (12.5%), and the lower part of the curtain (2.8%) at the same time.In the form of hemorrhage, most of them were macular, speckle, gyrus, linear hemorrhage, hematoma formation, hematoma formation, and hematoma formation at least 5.3N, 55.3%, 55.3%, 39.4%, 55.3%, 55.3%, 55.3%, 39.4%, 55.3%, 55.3% respectively.Among them, linear hemorrhage was most common in the lobes (89.2%), mottle like, and mottled hemorrhage in the basal ganglia (48.2%).ConclusionThe peak time of HT in embolism cerebral infarction was different from that in thrombotic cerebral infarction, and the time of HT in embolism cerebral infarction was earlier than that in thrombotic cerebral infarction.In this study, a new MRI classification of HT in cerebral infarction was proposed: type 鈪，

本文編號：1714547