本文關(guān)鍵詞： 灌注損傷 半球 頸動脈狹窄 顱內(nèi)動脈狹窄 支架治療 藥物規(guī)范治療　出處：《中國人民解放軍醫(yī)學(xué)院》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 分析單側(cè)頸內(nèi)動脈系統(tǒng)血管狹窄或閉塞后的灌注核磁表現(xiàn)，探討灌注核磁表現(xiàn)在缺血性腦血管病介入診療中的應(yīng)用。 資料與方法 1．在我院神經(jīng)內(nèi)科住院患者中選取符合條件的病例；入選標準為：1周內(nèi)有頸內(nèi)動脈系統(tǒng)缺血事件發(fā)生，包括腦梗死（CI)及短暫性腦缺血發(fā)作(TIA)；通過DSA證實病灶側(cè)頸內(nèi)動脈或大腦中動脈狹窄或閉塞,對側(cè)頸內(nèi)動脈系統(tǒng)無嚴重狹窄；核磁共振灌注影像存在相對應(yīng)的灌注缺損。 2．采集入選患者的一般臨床資料； 3．利用磁共振灌注成像技術(shù)（PWI)采集入選患者雙側(cè)大腦半球分水嶺區(qū)的灌注參數(shù)：局部腦血流量(rCBF)，局部腦血容量（rCBV），平均通過時間（MTT），達峰時間(TTP)。具體采集方法見后。根據(jù)灌注損傷的嚴重程度分為4期，作為PWI基線資料。 4.通過數(shù)字減影血管造影(DSA)對入組患者進行血管評估，包括狹窄或閉塞部位，代償途徑，TICI分級等，與PWI基線資料進行相關(guān)性研究。 5.經(jīng)DSA證實為癥狀性頸內(nèi)動脈顱外段嚴重狹窄的患者，予以支架治療，，并在術(shù)后72小時復(fù)查PWI；對癥狀性頸內(nèi)動脈系統(tǒng)顱內(nèi)段狹窄的患者予以藥物規(guī)范治療1周，如臨床癥狀緩解，繼續(xù)藥物治療，3個月后復(fù)查PWI；不能緩解者，予以顱內(nèi)動脈支架治療，術(shù)后72小時復(fù)查PWI；對動脈閉塞，或因其他原因不能行介入治療的患者，予以藥物規(guī)范治療，3月后復(fù)查PWI。所有復(fù)查PWI均與基線PWI進行對比。 結(jié)果 1．33例患者入組，其中男性23例，女性10例；年齡34-80（56.1±13.3）歲；短暫性腦缺血發(fā)作7例，新發(fā)腦梗死26例。 2.根據(jù)DSA結(jié)果以眼動脈及后交通動脈發(fā)出點為界，將頸內(nèi)動脈系統(tǒng)血管分為三段：頸內(nèi)動脈起始至眼動脈發(fā)出點為第一段，共12例，其中狹窄9例，閉塞3例；眼動脈發(fā)出點至后交通動脈發(fā)出點為第二段，共3例，其中狹窄1例，閉塞2例；后交通動脈發(fā)出點至大腦中動脈主干為第三段，共18例，其中狹窄8例，閉塞10例；無側(cè)支循環(huán)代償3例，以一級代償為主5例，二級代償為主24例，三級代償為主1例。TICI分級一級5例，二級23例，三級5例。 3.PWI基線損傷1期7例，2期17例，3期5例，4期4例。 4.8例頸內(nèi)動脈顱外段狹窄、1例大腦中動脈狹窄患者行介入支架治療；并于術(shù)后72小時復(fù)查PWI，結(jié)果均為正常。 5．24例規(guī)范藥物治療患者，于3月后復(fù)查PWI，與基線數(shù)值比較11例改善，13例未變化。 6．9例未經(jīng)介入治療的顱內(nèi)動脈狹窄患者經(jīng)規(guī)范藥物治療3個月，1例病變血管閉塞。 7．33例患者3個月內(nèi)臨床癥狀無加重。 結(jié)論 1．PWI在評價單側(cè)頸內(nèi)動脈系統(tǒng)缺血引起灌注損傷方面具有明確作用； 2．單側(cè)頸內(nèi)動脈系統(tǒng)動脈狹窄或閉塞后的灌注損傷程度與患者的年齡及TICI分級具有相關(guān)性； 3．介入支架治療可迅速且顯著的改善腦灌注損傷； 4．藥物規(guī)范治療在發(fā)生缺血事件3個月內(nèi)可有效控制灌注損傷加重；但不能阻止部分動脈狹窄程度加重。
[Abstract]:objective
To investigate the application of NMR imaging in the interventional diagnosis and treatment of ischemic cerebrovascular disease by analyzing the perfusion MRI findings of the unilateral internal carotid artery stenosis or occlusion.
Information and methods
1. in our hospital were selected in accordance with the conditions of the patient; inclusion criteria: 1 weeks of internal carotid artery system ischemic events, including cerebral infarction (CI) and transient ischemic attack (TIA); the DSA confirmed that the ipsilateral internal carotid artery or middle cerebral artery stenosis or occlusion of contralateral carotid no severe artery stenosis; magnetic resonance perfusion imaging has corresponding perfusion defect.
2. the general clinical data of the selected patients were collected.
3. the use of magnetic resonance perfusion imaging (PWI) perfusion parameters collecting selected patients with bilateral cerebral watershed: regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), mean transit time (MTT), time to peak (TTP). After the specific acquisition method. According to the severity of reperfusion injury 4, PWI as the baseline data.
4. through digital subtraction angiography (DSA), we performed vascular assessment for patients, including stenosis or occlusion, compensatory pathways, TICI grading, and so on, and were correlated with PWI baseline data.
5. confirmed by DSA for symptomatic extracranial internal carotid artery stenosis patients to stent, and in 72 hours after the operation was PWI; for symptomatic carotid artery stenosis in patients with intracranial system to drug treatment for 1 weeks, such as clinical symptoms, to drug treatment, after 3 months of PWI; can not be remission, intracranial artery stent, 72 hours after the operation was PWI; for arterial occlusion, or interventional treatment of patients can not be for other reasons, to drug treatment, after the March review of PWI. PWI and PWI were all baseline were compared.
Result
1.33 patients were enrolled in the group, including 23 males and 10 females, 34-80 (56.1 + 13.3) years of age, 7 transient ischemic attacks and 26 new cerebral infarction.
2. according to the results of DSA in ophthalmic artery and posterior communicating artery a point for the community, the internal carotid artery blood vessel is divided into three sections: the internal carotid artery and ophthalmic artery from point of the first paragraph, a total of 12 cases, the stenosis in 9 cases, 3 cases of ophthalmic artery occlusion; a point to point out the posterior communicating artery is divided into second sections among them, a total of 3 cases, 1 cases of stenosis, 2 cases of posterior communicating artery occlusion; a main artery to the brain is divided into third sections, a total of 18 cases, the stenosis in 8 cases, 10 cases of occlusion; no collateral circulation in 3 cases, with a compensatory mainly in 5 cases, 24 cases of grade two compensation, three for 1 cases of.TICI grade compensatory grade a grade 5 cases, 23 cases of grade two, grade three in 5 cases.
3.PWI baselines were damaged in 1 stages, 7 cases, 2 stage 17 cases, 3 stage 5 cases, 4 stage 4 cases.
4.8 cases of internal carotid artery stenosis, 1 cases of middle cerebral artery stenosis were treated with interventional stent, and PWI was rechecked 72 hours after operation. The results were all normal.
5.24 patients with standardized drug treatment were reexamined after March. Compared with the baseline values, 11 cases were improved and 13 cases were not changed.
6.9 cases of intracranial artery stenosis without interventional therapy were treated by standardized medication for 3 months, and 1 cases of vascular occlusion.
In 7.33 patients, the clinical symptoms were not aggravated within 3 months.
conclusion
1.PWI has a clear role in evaluating ischemia-reperfusion injury in unilateral internal carotid artery system.
2. the degree of perfusion injury after the stenosis or occlusion of the unilateral internal carotid artery system was correlated with the age and TICI classification of the patients.
3. interventional stent therapy can quickly and significantly improve cerebral perfusion injury.
4. medication can effectively control the aggravation of perfusion injury within 3 months of the occurrence of ischemic events, but it can not prevent the aggravation of the degree of partial artery stenosis.

【學(xué)位授予單位】：中國人民解放軍醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

【參考文獻】

相關(guān)期刊論文 前1條

1 陳婷;郭大靜;趙建農(nóng);方正;;全腦CT灌注成像在短暫性腦缺血發(fā)作中的初步應(yīng)用[J];第三軍醫(yī)大學(xué)學(xué)報;2011年23期

本文編號：1506520