本文關(guān)鍵詞： 缺血性腦卒中 中國(guó)缺血性卒中亞型 OCSP分型 預(yù)后　出處：《蘭州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：通過(guò)對(duì)急性缺血性腦卒中住院患者進(jìn)行中國(guó)缺血性卒中亞型(Chinese Ischemic Stroke Subclassification, CISS)分型和英國(guó)牛津郡社區(qū)卒中計(jì)劃(Oxfordshire Community Stroke Project, OCSP)分型,了解各亞型的構(gòu)成情況、兩種分型方法的特性以及兩者間的關(guān)系,并在此基礎(chǔ)上探討CISS分型聯(lián)合OCSP分型在評(píng)估患者病情和預(yù)后方面的臨床應(yīng)用價(jià)值。 方法：連續(xù)收集蘭州大學(xué)第二醫(yī)院神經(jīng)內(nèi)科急性缺血性腦卒中住院患者300例,按照CISS和OCSP標(biāo)準(zhǔn)分別將患者分為具體亞型,觀察并比較住院患者中兩種分型系統(tǒng)各亞型的分布情況。應(yīng)用美國(guó)國(guó)立衛(wèi)生研究院卒中量表(National Institutes of Health Stroke Scale, NIHSS)評(píng)定患者入院及出院時(shí)神經(jīng)功能狀態(tài),以出院時(shí)神經(jīng)功能好轉(zhuǎn)率評(píng)價(jià)其臨床短期預(yù)后,分析CISS各亞型和OCSP各亞型患者的病情和預(yù)后情況。 結(jié)果：1.CISS分型中各亞型的構(gòu)成由高到低依次為：穿支動(dòng)脈疾病127例(42.3%),大動(dòng)脈粥樣硬化98例(32.7%),病因不確定51例(17.0%),心源性卒中19例(6.3%),其他病因5例(1.7%)。5種亞型中穿支動(dòng)脈疾病所占比例最高(x2=178.67,P0.001)。OCSP分型中各亞型的構(gòu)成由高到低依次為：腔隙性梗死138例(46.0%),部分前循環(huán)梗死91例(30.3%),完全前循環(huán)梗死40例(13.3%),后循環(huán)梗死31例(10.3%)。4種亞型中腔隙性梗死所占比例最高(X2=98.48,P0.001)。 2.兩種分型方法的相關(guān)性研究結(jié)果如下：CISS分型中,大動(dòng)脈粥樣硬化患者臨床多表現(xiàn)為部分前循環(huán)梗死(46.9%,x2=26.49,P0.001),穿支動(dòng)脈疾病患者臨床多表現(xiàn)為腔隙性梗死(80.3%, x2=211.68, P0.001). OCSP分型中,完全前循環(huán)梗死患者的主要病因?yàn)榇髣?dòng)脈粥樣硬化(55.0%,x2=33.25,P0.001),其次為心源性卒中(20.0%)；部分前循環(huán)梗死及后循環(huán)梗死患者的主要病因均為動(dòng)脈粥樣硬化(50.5%,48.4%; x2=63.78, x2=19.81; P0.001, P=0.001);腔隙性梗死患者的主要病因?yàn)榇┲?dòng)脈疾病(73.9%,X2=181.71,P0.001)。 3.不同亞型患者的病情和預(yù)后情況如下：CISS分型中,穿支動(dòng)脈疾病患者入院時(shí)NIHSS評(píng)分最低(4.67±1.77)分、病情最輕,出院時(shí)神經(jīng)功能好轉(zhuǎn)率最高(50+13)%、預(yù)后最好；心源性卒中患者入院時(shí)NIHSS評(píng)分最高(14.634±4.63)分、病情最重,出院時(shí)神經(jīng)功能好轉(zhuǎn)率最低(25+9)%、預(yù)后最差。OCSP分型中,腔隙性梗死患者入院時(shí)NIHSS評(píng)分最低(4.71±1.67)分、病情最輕,出院時(shí)神經(jīng)功能好轉(zhuǎn)率最高(50士13)%、預(yù)后最好；完全前循環(huán)梗死患者入院時(shí)NIHSS評(píng)分最高(12.28±4.39)分、病情最重,出院時(shí)神經(jīng)功能好轉(zhuǎn)率最低(24±26)%、預(yù)后最差。 4. CISS分型與OCSP分型聯(lián)合應(yīng)用,對(duì)急性缺血性腦卒中患者病情和預(yù)后的評(píng)估結(jié)果如下：臨床癥狀表現(xiàn)為腔隙性梗死同時(shí)病因?yàn)榇┲?dòng)脈疾病的患者一般病情較輕、預(yù)后較好；臨床癥狀表現(xiàn)為完全前循環(huán)梗死同時(shí)病因?yàn)樾脑葱运ㄈ幕颊叨鄶?shù)病情重、預(yù)后差。 結(jié)論：1OCSP分型以患者的臨床表現(xiàn)為診斷依據(jù),可在急性期未完善相關(guān)檢查的情況下指導(dǎo)缺血性腦卒中患者的早期治療。 2. CISS分型既有病因診斷又有發(fā)病機(jī)制診斷,可為腦梗死患者的病因治療和二級(jí)預(yù)防提供更準(zhǔn)確的參考意見(jiàn)。 3. CISS分型與OCSP分型之間有一定的相關(guān)性。 4. CISS分型和OCSP分型均能有效評(píng)估缺血性腦卒中患者的病情和預(yù)后。 5. CISS分型和OCSP分型聯(lián)合應(yīng)用可對(duì)腦梗死患者的病情和預(yù)后做出綜合性的評(píng)價(jià),為缺血性腦卒中的有效防治提供更準(zhǔn)確的參考依據(jù)。
[Abstract]:Objective : To study the clinical application value of CISS classification in evaluating the condition and prognosis of patients with acute ischemic stroke in Chinese Stroke Stroke Subclassification ( CISS ) typing and the British Oxford Community Stroke Project . Methods : 300 patients with acute ischemic stroke in the Second Affiliated Hospital of Lanzhou University were continuously collected , and the patients were divided into specific subtypes according to CISS and the criteria of the criteria . The distribution of the subtypes of the two typing systems was observed and compared . The clinical short - term prognosis was evaluated by using the National Institutes of Health Stroke Scale ( NIHSS ) . The clinical short - term prognosis of patients with CISS and the patients with different subtypes were analyzed . Results : 1 . The composition of each sub - subtype in CISS typing was from high to low in order : 127 cases ( 42.3 % ) through branch artery disease , 98 cases of atherosclerosis ( 32.7 % ) , 51 cases ( 17.0 % ) , 19 cases of cardiac stroke ( 6.3 % ) , 5 cases of other causes ( 1.7 % ) , and the highest proportion of penetrating branch artery disease among 5 subtypes ( x2 = 178.67 , P0.001 ) . There were 138 cases of lacunar infarction ( 46.0 % ) , 91 cases of partial anterior circulation infarction ( 30 . 3 % ) , 40 cases of complete anterior circulation infarction ( 13.3 % ) , 31 cases of posterior circulation infarction ( 10.3 % ) , and the highest proportion of lacunar infarction ( X2 = 98.48 , P0.001 ) . 2 . The results of the correlation between the two typing methods were as follows : In CISS classification , the clinical manifestations of patients with atherosclerosis were partial anterior circulation infarction ( 46.9 % , x2 = 26.49 , P0.001 ) , and the clinical manifestations of transarterial disease were lacunar infarction ( 80.3 % , x2 = 211.68 , P0.001 ) . The main causes of the patients with complete anterior circulation infarction were atherosclerosis ( 55.0 % , x2 = 33.25 , P0.001 ) , followed by cardiac stroke ( 20.0 % ) ; the major causes of partial anterior circulation infarction and post - cycle infarction were atherosclerosis ( 50.5 % , 48.4 % ; x2 = 63.78 , x2 = 19.81 ; P0.001 , P = 0.001 ) ; the primary disease in lacunar infarction was due to transarterial disease ( 73.9 % , X2 = 181.71 , P0.001 ) . 3 . The condition and prognosis of patients with different subtypes were as follows : In CISS classification , NIHSS score was the lowest ( 4.67 鹵 1.77 ) at admission , the highest ( 14.634 鹵 4.63 ) % , and the worst prognosis . The NIHSS score was the highest ( 12.28 鹵 4.39 ) at discharge and the worst prognosis . At discharge , NIHSS score was the highest ( 12.28 鹵 4.39 ) , the lowest was ( 24 鹵 26 ) % , and the prognosis was worst . 4 . The combined application of CISS typing and ocsp typing in patients with acute ischemic stroke is as follows : the clinical symptoms appear as lacunar infarction while the patients with transarterial disease are generally mild and have good prognosis ; the clinical symptoms manifest as complete anterior circulation infarction while the majority of patients with cardiac embolism are serious and the prognosis is poor . Conclusion : The clinical manifestations of the patients can be diagnosed according to the clinical manifestations of the patients , and the early treatment of ischemic stroke patients can be guided without complete correlation examination in the acute phase . 2 . CISS typing has both etiological diagnosis and pathogenesis diagnosis , which can provide more accurate reference for the etiological treatment and secondary prevention of cerebral infarction patients . 3 . There is a certain correlation between CISS typing and classification . 4 . Both the CISS classification and the classification can effectively assess the condition and prognosis of ischemic stroke patients . 5 . The combined application of CISS typing and the classification can provide a more accurate reference for the effective prevention and treatment of ischemic stroke .

【學(xué)位授予單位】：蘭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R743.3

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