發(fā)布時(shí)間：2018-03-06 16:43

  本文選題：腦橋旁正中梗死　切入點(diǎn)：腦橋腔隙性梗死　出處：《揚(yáng)州大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：[目的] 對(duì)比研究腦橋旁正中梗死(Paramedian Pontine Infarction, PPI)與腦橋腔隙性梗死(Lacunar Pontine Infarction, LPI)的臨床和影像學(xué)特征,探討其早期運(yùn)動(dòng)障礙進(jìn)展及短期預(yù)后的影響因素,以及高分辨率磁共振(high-resolution magnetic resonance angiography, HRMRI)在基底動(dòng)脈斑塊成像方面的臨床應(yīng)用。 [方法] 回顧性分析了初次發(fā)病24h內(nèi)的孤立性腦橋梗死患者共86例,發(fā)病后72h內(nèi)完成磁共振彌散加權(quán)成像(Diffusion-Weighted Imaging, DWI)和磁共振血管成像(Magnetic Resonance Angiography, MRA),其中10例PPI患者完成基底動(dòng)脈高分辨率磁共振成像。86例患者分組：①根據(jù)梗死灶最大直徑及位置分組：PPI組(35例,病灶直徑15mm,累及腦橋腹側(cè)表面)；LPI組(51例,病灶直徑≤15mm,位于腦橋內(nèi)部)。②根據(jù)早期是否存在運(yùn)動(dòng)障礙進(jìn)展(progressive motor deficits, PMD)分為PMD組(22例)與無(wú)PMD組(64例)。③根據(jù)發(fā)病1月時(shí)改良的Rankin殘障量表(modified Rankin Scale, mRS)評(píng)分,分為轉(zhuǎn)歸不良組(mRS2分,35例)與轉(zhuǎn)歸良好組(mRS≤2分,51例)。分別比較兩組的臨床特點(diǎn)及影響因素。 [結(jié)果] 1.PPI組與LPI組比較,PPI組高脂血癥比例[20/35(57.14%)]明顯高于LPI組[17/51(33.33%),x2=4.80,P=0.028]；PPI組入院時(shí)NIHSS評(píng)分明顯高于LPI組(6.00±2.39vs4.61±3.41,t=2.087,P=0.040)；PPI組臨床表現(xiàn)偏癱比例[34/35(97.14%)]明顯高于LPI組[37/51(72.55%),x2=8.718,P=0.003]；PPI組基底動(dòng)脈狹窄比例[16/35(45.71%)]明顯高于LPI組[9/51(17.65%),x2=7.930,P=0.005]；PPI組mRS2分比例[19/35(54.29%)]明顯高于LPI組[16/51(31.37%),x2=4.515,P=0.034]。 2.PMD組與無(wú)PMD組比較,PMD組入院時(shí)舒張壓明顯高于無(wú)PMD組(97.82±15.61vs89.55±12.23,t=2.258, P=0.031); PMD組中PPI比例[14/22(63.64%)]明顯高于無(wú)PMD組[21/64(32.81%),x2=6.445,P=0.011]。PMD組基底動(dòng)脈狹窄比例[13/22(59.10%)]明顯高于無(wú)PMD組[12/64(18.75%),x2=12.922,P=0.000)]。 3.轉(zhuǎn)歸不良組與轉(zhuǎn)歸良好組比較,前者入院時(shí)NIHSS評(píng)分、空腹血糖值明顯高于后者(6.80±2.63vs3.73±2.55, t=5.426, P=0.000;9.40±5.15vs6.56±2.69,t=2.985, P=0.004);轉(zhuǎn)歸不良組中PPI比例[19/35(54.29%)]明顯高于LPI[16/51(31.37%),x2=4.515, P=0.034]。 Logistic回歸分析發(fā)現(xiàn)基底動(dòng)脈狹窄與PPI的發(fā)生呈正相關(guān)(OR=3.801,95%CI1.357-10.646, P=0.011);基底動(dòng)脈狹窄是孤立性腦橋梗死早期運(yùn)動(dòng)障礙進(jìn)展的獨(dú)立危險(xiǎn)因素(OR=4.571,95%CI1.214-17.214, P=0.025);入院時(shí)NIHSS評(píng)分≥5分是其短期預(yù)后不良的獨(dú)立危險(xiǎn)因素(OR=4.277,95%CI1.505-12.151, P=0.006)。 4.10例PPI患者行基底動(dòng)脈HRMRI檢查,其中有8例發(fā)現(xiàn)基底動(dòng)脈有大小不一的動(dòng)脈粥樣硬化斑塊。 [結(jié)論] 1.PPI病因主要是基底動(dòng)脈分支病變,與基底動(dòng)脈主干動(dòng)脈粥樣硬化有關(guān)。 2.孤立性腦橋梗死入院時(shí)NIHSS評(píng)分≥5分可能導(dǎo)致其短期預(yù)后不良。 3.孤立性腦橋梗死早期運(yùn)動(dòng)障礙進(jìn)展及短期預(yù)后不良均可能與基底動(dòng)脈病變有關(guān)。
[Abstract]:[purpose]. To compare the clinical and imaging features of Paramedian Pontine Infarction (PPII) and lacunar Pontine Infarction (LPI) in patients with paracontine infarction and lacunar Pontine Infarction (LPI), and to explore the factors influencing the progression of early motor disorders and the short-term prognosis. And the clinical application of high resolution magnetic resonance (HRMRI) in basilar artery plaque imaging. [methods]. A retrospective analysis of 86 patients with solitary pons infarction within 24 hours of initial onset was made. Diffusion-weighted imaging (DWI) and magnetic Resonance angiography (MRAA) were completed within 72 hours after onset of the disease. Among them, 10 patients with PPI completed high-resolution magnetic resonance imaging of the basilar artery. 86 patients were divided into groups: 1 according to the maximum diameter of the infarct and. Position group: PPI group: 35 cases, The lesions were 15 mm in diameter and 51 cases in the LPI group involving the ventral surface of the pontine. The lesion diameter 鈮，

本文編號(hào)：1575641