本文選題：腦梗死 + 大面積腦梗死��； 參考：《第二軍醫(yī)大學(xué)》2013年碩士論文

【摘要】：[目的]：本研究通過(guò)觀察急性頸內(nèi)動(dòng)脈系統(tǒng)大面積腦梗死與局灶性腦梗死在頭顱CT未顯影階段腦電圖相對(duì)波段功率的分布差異以及動(dòng)態(tài)監(jiān)測(cè)急性大面積大腦中動(dòng)脈供血區(qū)梗死起病后不同時(shí)間段的的相對(duì)波段功率變化趨勢(shì),旨在探討腦電圖相對(duì)波段功率在急性頸內(nèi)動(dòng)脈系統(tǒng)缺血性腦卒中的早期診斷價(jià)值及重癥卒中預(yù)后評(píng)估方面的臨床應(yīng)用價(jià)值。通過(guò)本研究為卒中單元的神經(jīng)監(jiān)護(hù)模式發(fā)展提供一種客觀、直觀、易于床邊監(jiān)測(cè)的腦功能監(jiān)測(cè)方法。 [方法]：本研究的研究組分為早期診斷組、動(dòng)態(tài)趨勢(shì)變化組,兩組分別設(shè)置對(duì)照組。 早期診斷組：該研究組共計(jì)納入急性頸內(nèi)動(dòng)脈系統(tǒng)腦梗死患者38例(局灶性腦梗死20例,大面積腦梗死18例),EEG正常的同期住院患者30例(對(duì)照組)。對(duì)研究組患者及招募的對(duì)照組患者分別采取8通道中央導(dǎo)聯(lián)的記錄模式進(jìn)行常規(guī)EEG及RBP趨勢(shì)圖監(jiān)測(cè),研究組保證發(fā)病24內(nèi)完成床邊EEG檢查,每次至少監(jiān)測(cè)30分鐘。觀察梗死部位腦區(qū)與對(duì)側(cè)腦區(qū)、梗死側(cè)枕部腦區(qū)與健側(cè)枕部腦區(qū)的RBP變化并對(duì)比分析。比較局灶性腦梗死、大面積腦梗死、正常對(duì)照組的RBP差異。 動(dòng)態(tài)趨勢(shì)變化組：本研究組共計(jì)納入急性大腦中動(dòng)脈供血區(qū)大面積腦梗死患者30例,同期住院患者30例(對(duì)照組)。對(duì)研究組患者分別在發(fā)病后48小時(shí)內(nèi)、第5-6天、第10-11天進(jìn)行床旁EEG監(jiān)測(cè),記錄患者的一般資料、并發(fā)癥及實(shí)驗(yàn)室檢查結(jié)果。對(duì)照組患者相應(yīng)在入院后48小時(shí)內(nèi)、第5-6天、第10-11天進(jìn)行床旁EEG監(jiān)測(cè)。在起病1個(gè)月時(shí)進(jìn)行臨床隨訪觀察,根據(jù)是否存活,分為存活組及死亡組,回顧性分析兩組腦梗死患者在發(fā)病后48小時(shí)內(nèi)、第5-6天、第10-11天三個(gè)階段時(shí)的腦電圖RBP動(dòng)態(tài)變化趨勢(shì),進(jìn)一步比較存活組、死亡組、對(duì)照組間RBP趨勢(shì)變化的差異。 [結(jié)果]： 第一部分： 梗死部位腦區(qū)與對(duì)側(cè)腦區(qū)比較：局灶性梗死組在各波段RBP上均表現(xiàn)為不對(duì)稱性,病灶部位腦區(qū)δ波、θ波RBP較對(duì)側(cè)顯著增大(P0.01),α波、β波的RBP顯著減低(P0.01)；大面積梗死組RBP的分布亦存在不對(duì)稱性,患側(cè)腦區(qū)δ波RBP較對(duì)側(cè)顯著增大(P0.01),α波、β波的RBP顯著減低(P0.01),但θ波RBP雙側(cè)對(duì)比無(wú)明顯統(tǒng)計(jì)學(xué)差別(P0.05)。與對(duì)照組比較,兩組腦梗死患者梗死腦區(qū)均表現(xiàn)為δ波、θ波RBP增大(P0.01),α波、β波的RBP減低(P0.01)。枕部RBP變化：兩組不同面積腦梗死患者,雙側(cè)枕部各波段RBP上均表現(xiàn)為不對(duì)稱性,梗死側(cè)枕部較健側(cè)枕部δ波、θ波RBP值增大,α波、β波的RBP降低(P0.05)；健側(cè)枕部RBP與對(duì)照組比較,大面積組表現(xiàn)為δ波、θ波RBP增大,α波、β波的RBP降低(P0.05),局灶性組中,除θ波RBP輕微增高外,δ波、α波、β波RBP均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。 第二部分： 1、梗死腦區(qū)RBP于48h內(nèi)、5-6天、10-11天三階段趨勢(shì)變化。 死亡組、存活組患者住院期間梗死腦區(qū)δ、0、α、β波段的RBP值均有隨時(shí)間變化的趨勢(shì),并且兩組變化趨勢(shì)存在差異(P0.05),而對(duì)照組四個(gè)波段的RBP值三次監(jiān)測(cè)中未發(fā)現(xiàn)明顯變化(P0.05)；兩組腦梗死患者的梗死腦區(qū)6、θ波RBP值三個(gè)時(shí)間段均顯著高于對(duì)照組,α、β波RBP值均顯著低于對(duì)照組(P0.05)。兩組腦梗死患者住院時(shí)梗死部位腦區(qū)的δ、θ、α、β波RBP值無(wú)明顯差異(P0.05)。死亡組的δ波段RBP值三次監(jiān)測(cè)中表現(xiàn)為持續(xù)上升趨勢(shì)；存活組表現(xiàn)為先上升、后下降的趨勢(shì),10天時(shí)僅略高于入院時(shí)水平；5-6天時(shí)死亡組δ波RBP值上升的幅度遠(yuǎn)高于存活組。死亡組的梗死部位腦區(qū)θ波段RBP值三次監(jiān)測(cè)中表現(xiàn)為持續(xù)下降趨勢(shì)；存活組表現(xiàn)為先下降,中后期監(jiān)測(cè)無(wú)明顯變化；中期監(jiān)測(cè)結(jié)果兩組無(wú)明顯差異。死亡組的梗死部位腦區(qū)α波段RBP值三次監(jiān)測(cè)中表現(xiàn)為持續(xù)下降趨勢(shì)；存活組α波段RBP值在1周內(nèi)基本維持在入院時(shí)水平,此后逐漸升高,但10天時(shí)仍未恢復(fù)至正常水平；死亡組α波段RBP值整體趨勢(shì)顯著低于存活組。死亡組β波RBP值住院期間表現(xiàn)為先下降,再輕度回升的趨勢(shì),10天時(shí)仍低于入院時(shí)水平；存活組β波RBP值1周內(nèi)基本維持在入院時(shí)水平,此后有逐漸升高趨勢(shì);死亡組β波段RBP值整體趨勢(shì)顯著低于存活組。 2、病灶對(duì)側(cè)腦區(qū)RBP于48h內(nèi)、5-6天、10-11天三階段趨勢(shì)變化 死亡組、存活組患者住院期間梗死對(duì)側(cè)腦區(qū)δ、θ、α、β波段的RBP值均有隨時(shí)間變化的趨勢(shì),并且兩組變化趨勢(shì)存在明顯統(tǒng)計(jì)學(xué)差異(P0.05),而對(duì)照組四個(gè)波段的RBP值三次監(jiān)測(cè)中未發(fā)現(xiàn)明顯變化(P0.05)；兩組腦梗死患者的梗死對(duì)側(cè)腦區(qū)δ、0波RBP值三個(gè)時(shí)間段均顯著高于對(duì)照組,α、β波RBP值均顯著低于對(duì)照組(P0.05)。死亡組梗死灶對(duì)側(cè)腦區(qū)δ波RBP值入院期間表現(xiàn)為逐漸上升趨勢(shì)；存活組病灶對(duì)側(cè)腦區(qū)δ波RBP值在6天內(nèi)逐漸升高,此后逐漸下降,10天時(shí)基本恢復(fù)至入院時(shí)水平；存活組病灶對(duì)側(cè)腦區(qū)6波RBP值的整體趨勢(shì)遠(yuǎn)低于死亡組,三次監(jiān)測(cè)中差值有逐漸增大的趨勢(shì)。死亡組梗死灶對(duì)側(cè)腦區(qū)0波RBP值三次監(jiān)測(cè)中表現(xiàn)為逐漸下降趨勢(shì)；存活組,梗死灶對(duì)側(cè)腦區(qū)的0波段RBP變化趨勢(shì)為6天內(nèi)逐漸下降,后兩次監(jiān)測(cè)結(jié)果無(wú)明顯差異;死亡組病灶對(duì)側(cè)腦區(qū)e波RBP值的整體趨勢(shì)遠(yuǎn)低于存活組。死亡組梗死灶對(duì)側(cè)腦區(qū)α波RBP值的變化趨勢(shì)為先下降,6-10天基本維持在較低水平不變；存活組梗死對(duì)側(cè)腦區(qū)α波的變化趨勢(shì)為先逐漸下降,爾后逐漸上升,10-11天基本恢復(fù)到入院時(shí)水平；死亡組病灶對(duì)側(cè)腦區(qū)α波RBP值的整體趨勢(shì)遠(yuǎn)低于存活組。死亡組病灶對(duì)側(cè)腦區(qū)β波RBP值變化趨勢(shì)為,5-6天逐漸下降到較低值,10-11天時(shí)略有回升,但仍低于入院時(shí)檢測(cè)值；存活組,住院期間先呈下降趨勢(shì),此后逐漸升高,第三次監(jiān)測(cè)結(jié)果已高于入院時(shí)水平；兩組入院時(shí)處于相同水平,此后的下降趨勢(shì)中死亡組的下降幅度遠(yuǎn)大于存活組,降低至較低水平,10-11天時(shí)仍未有大幅度回升。 3、梗死腦區(qū)與對(duì)側(cè)腦區(qū)趨勢(shì)變化的配對(duì)比較 死亡組與存活組患者住院期間雙側(cè)腦區(qū)的α、β、0、δ波段的RBP值均有隨測(cè)量時(shí)間段變化的趨勢(shì)；死亡組的四個(gè)波段在雙側(cè)腦區(qū)的變化趨勢(shì)均具有不一致性；存活組6、α、β波段雙側(cè)腦區(qū)的變化趨勢(shì)具有不一致性,0波段的變化趨勢(shì)還不能認(rèn)為雙側(cè)存在統(tǒng)計(jì)學(xué)差異。兩組患者住院期間四個(gè)波段雙側(cè)腦區(qū)的分布水平均呈現(xiàn)不對(duì)稱性,梗死腦區(qū)的α、β波RBP值三個(gè)時(shí)間段均顯著低于對(duì)側(cè)腦區(qū),δ波RBP值均顯著高于對(duì)側(cè)腦區(qū),死亡組α波的雙側(cè)不對(duì)稱性有逐漸增大的趨勢(shì)；死亡組患者入院時(shí)梗死腦區(qū)θ波段RBP值高于對(duì)側(cè),此后兩次監(jiān)測(cè)雙側(cè)腦區(qū)的0波段RBP值均呈下降趨勢(shì),梗死腦區(qū)的下降幅度遠(yuǎn)大于對(duì)側(cè),中后期監(jiān)測(cè)時(shí),梗死腦區(qū)顯著低于對(duì)側(cè)腦區(qū)；存活組入院時(shí)雙側(cè)腦區(qū)0波段基本對(duì)稱,此后漸呈現(xiàn)出不對(duì)稱性,中后期監(jiān)測(cè)時(shí),梗死側(cè)腦區(qū)的0波段RBP值均顯著低于對(duì)側(cè)。 [結(jié)論]：1、腦電圖RBP對(duì)于CT尚未顯影階段的急性頸內(nèi)動(dòng)脈系統(tǒng)腦梗死具有早期定側(cè)意義,結(jié)合枕部的RBP變化,可初步鑒別大面積腦梗死。2、急性大面積大腦中動(dòng)脈供血區(qū)梗死患者梗死腦區(qū)、對(duì)側(cè)腦區(qū)的α、β、θ、δ波段RBP值住院期間均有隨監(jiān)測(cè)時(shí)間段變化的趨勢(shì),1個(gè)月時(shí)存活患者與死亡患者住院期間各波段RBP變化趨勢(shì)均呈現(xiàn)明顯的差異性。重癥半球梗死患者住院期間RBP變化趨勢(shì)的動(dòng)態(tài)監(jiān)測(cè)可及時(shí)反映其腦功能變化,對(duì)于評(píng)估病情及一個(gè)月時(shí)的生存機(jī)會(huì)具有重要價(jià)值。
[Abstract]:[Objective] to observe the distribution difference of the relative band power of the acute cerebral infarction and focal cerebral infarction in the undeveloped CT stage of the acute internal carotid artery system and the dynamic monitoring of the change trend of the relative band power in the acute large area of the acute large area of the middle cerebral artery supply area after the infarction. The clinical value of the EEG relative band power in the early diagnosis of the acute internal carotid artery system ischemic stroke and the evaluation of the prognosis of severe stroke. This study provides an objective, intuitive, and easy to monitor method of brain function monitoring for the development of the neural monitoring model for stroke unit.
[method] the research group of this study was divided into early diagnosis group, dynamic trend change group, and the two groups were set up control group respectively.
Early diagnosis group: the study group included 38 patients with acute internal carotid artery system cerebral infarction (20 cases of focal cerebral infarction, 18 cases of large area cerebral infarction), 30 cases of normal EEG hospitalized patients (control group). In the study group and the recruited control group, the 8 channel central lead recording mode was adopted for routine EEG and RBP chemotaxis. The study group ensured that the bedside EEG examination was completed within 24 of the onset of the disease for at least 30 minutes each time. The changes in the cerebral area of the infarct site and the contralateral brain region, the occipital cerebral area of the infarct side and the lateral occipital region of the healthy side were compared and analyzed. The differences in the RBP difference between the focal cerebral infarction, the large area cerebral infarction and the normal control group were compared.
Dynamic trend change group: 30 cases of acute cerebral infarction in the middle cerebral artery blood supply area were included in this study group, and 30 patients in the same period were hospitalized (control group). The patients in the study group were monitored by bedside EEG within 48 hours, 5-6 days, and 10-11 days after the onset of the disease, and the general data, complications and laboratory results were recorded. After 48 hours of admission, 48 hours, 5-6 days and 10-11 days after admission, the patients were followed up for 1 months. According to the survival, the patients were divided into the survival group and the death group. The dynamic changes of the electroencephalogram (RBP) of the two groups of cerebral infarction patients in 48 hours after the onset, the 5-6 day, and the three stage 10-11 days at the 10-11 day were analyzed. Trends were further compared between the survival group, the death group and the control group with the difference in the trend of RBP.
[results]:
Part one:
Compared with the contralateral brain area, the infarct area was asymmetrical on the RBP of the focal infarction group, the delta wave in the brain region of the lesion and the RBP of the theta wave were significantly increased (P0.01), the RBP of the alpha wave and the beta wave decreased significantly (P0.01). The distribution of RBP in the large area infarction group was also asymmetrical, and the delta wave RBP was significantly increased (P0) in the affected side of the cerebral area (P0). .01), the RBP of the alpha wave and beta wave decreased significantly (P0.01), but there was no significant difference between the two sides of theta wave RBP (P0.05). Compared with the control group, the infarct brain regions of the two groups of cerebral infarction were all delta wave, theta RBP increase (P0.01), alpha wave, RBP reduction (P0.01) of beta wave, and the change of occipital RBP: two groups of different area cerebral infarction patients, bilateral occipital bands RBP on each band Compared with the healthy lateral occipital region, the RBP value of the lateral occipital lobe was increased, the RBP of the alpha wave and the beta wave decreased (P0.05). Compared with the control group, the lateral occipital RBP in the healthy side showed delta wave, theta wave RBP increased, the RBP decreased (P0.05) in the alpha wave and beta wave, and there was no statistical difference between the delta wave, the alpha wave and the beta wave RBP in the focal group. Differences (P0.05).
The second part:
1, the infarct area RBP changes in 48h, 5-6 days, 10-11 days and three stages.
In the death group, the RBP values in the infarct brain region of the patients in the survival group were changed with time, and the change trend of the two groups was different (P0.05), while the RBP value of the four bands in the control group was not significantly changed in the three time monitoring (P0.05); the two group of cerebral infarction patients had 6 and three RBP values of theta wave, three time Duan Junxian. The RBP values of alpha and beta waves were significantly lower than those in the control group (P0.05). There was no significant difference in the value of delta, theta, alpha and beta wave RBP in the cerebral infarction area of the two groups of cerebral infarction (P0.05). The RBP value in the delta band of the dead group showed a continuous upward trend in the three monitoring of the delta band RBP value; the survival group showed a rising, then declining trend, only slightly higher than the 10 day. At the time of admission, the increase in the RBP value of the delta wave in the death group was much higher than that in the survival group at 5-6 days. The RBP value of the cerebral area in the infarct area of the dead group showed a continuous downward trend in the three monitoring. The survival group was first descended, and the middle and late monitoring had no obvious changes; there was no significant difference in the middle and late monitoring results between the two groups. The alpha band RBP value of the region showed a continuous downward trend in the three time monitoring. The RBP value of the alpha band in the survival group was basically maintained at the admission level within 1 weeks, and then gradually increased, but still did not recover to the normal level at 10 days. The overall trend of the RBP value in the alpha band of the death group was significantly lower than that in the survival group. The RBP value of the death group was first decreased during the period of hospitalization. The trend of mild recovery was still lower than the level of admission at 10 days. The RBP value of the survival group was basically maintained at the admission level in 1 weeks, and then the trend was gradually rising, and the overall trend of the RBP value in the beta band of the death group was significantly lower than that in the survival group.
2, the changes of RBP in 48h, 5-6 days, 10-11 days and three stages in the contralateral brain area.
In the death group, the RBP values of the infarct contralateral brain region in the infarct contralateral brain were changed with time, and there was a significant statistical difference between the two groups (P0.05), while the RBP values in the four bands of the control group were not significantly altered in the three time monitoring (P0.05), and the infarct to lateral brain area of the two cerebral infarction patients was Delta, 0 wave. The value of RBP in three time periods was significantly higher than that in the control group, and the RBP value of alpha and beta wave was significantly lower than that of the control group (P0.05). The delta wave RBP value of the infarct area in the death group was gradually rising, and the RBP value of the Delta wave in the lateral brain area of the survival group gradually increased in 6 days, and then gradually descended at 10 days, and then basically recovered to the level of admission. The overall trend of the 6 wave RBP value in the lateral brain region of the live group was much lower than that in the death group. The difference in the three monitoring was gradually increasing. The 0 wave RBP value of the 0 wave in the lateral brain area of the death group was gradually decreasing; the survival group, the 0 band RBP of the infarct to the lateral brain area was gradually decreased in 6 days, and the last two monitoring results were found. There was no significant difference. The overall trend of the E wave RBP value in the lateral brain area of the death group was much lower than that in the survival group. The change trend of the RBP value of the alpha wave in the lateral brain area of the death group was first decreased, and the 6-10 day was basically maintained at the lower level. The change trend of the alpha wave in the lateral brain area of the survival group was gradually decreased, then the 10-11 day was gradually rising, and the basic level of the infarction in the lateral brain area was gradually increased. The overall trend of the alpha wave RBP value in the lateral brain area of the death group was much lower than that in the survival group. The trend of the RBP value of the beta wave in the lateral brain area of the death group was gradually decreased to the lower value in the 5-6 day, but it was slightly lower at the 10-11 day, but still lower than the admission test value. The results of the third monitoring were higher than the level of admission. The two groups were at the same level when they were admitted to the hospital. The decline of the death group was much larger than that of the survival group, which was lower to the lower level, and there was still no significant recovery at 10-11 days.
3, paired comparisons of infarcted brain areas and contralateral brain regions.
The RBP values in the bilateral brain regions of both the death group and the survival group had a tendency to change with the measured time period, and the changes in the four bands of the death group were inconsistent in the bilateral brain regions; the survival group was 6, the changes of the bilateral brain regions in the alpha and beta bands were inconsistent, and the change trend in the 0 band was not yet possible. There was a statistical difference between the two sides of the two groups. The levels of bilateral brain regions in the four bands of the two groups were asymmetrical. The three periods of alpha and beta wave in the infarct brain region were significantly lower than those in the contralateral brain, and the RBP value of the delta wave was significantly higher than that in the contralateral brain, and the bilateral asymmetry of the alpha wave in the death group was gradually increased. At the time of admission, the RBP value of the infarct brain area was higher than the contralateral side, and the 0 band RBP values of the bilateral brain regions were decreased in two times. The decrease in infarct brain area was much larger than that in the contralateral side. The infarct brain area was significantly lower than that in the contralateral brain area in the middle and late stage. The 0 band of bilateral brain area in the survival group was basically symmetrical when the survival group was hospitalized. In the middle and later stages of monitoring, the 0 band RBP values in the infarcted side were significantly lower than those in the contralateral side.
[conclusion]:1, electroencephalogram RBP has the early side significance for acute cerebral infarction in the acute internal carotid artery system of CT, and combined with the changes of RBP in the occipital region, it can identify the large area cerebral infarction.2, acute large area cerebral artery blood supply area infarcted brain area, and the alpha, beta, theta and delta RBP values in the lateral brain area are monitored during the hospitalization. The trend of the change of the time segment of the patient was significantly different in the RBP changes during the 1 months of hospitalization. The dynamic monitoring of the RBP trend in patients with severe hemispheric infarction can reflect the changes in the brain function in time, which is of great value for assessing the condition and the chance of survival at one month.
【學(xué)位授予單位】：第二軍醫(yī)大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R542.22

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本文編號(hào)：1963667