本文選題：前循環(huán)　切入點(diǎn)：腦梗死　出處：《南昌大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：應(yīng)用數(shù)字減影血管造影技術(shù)對前循環(huán)系統(tǒng)血管病變所致腦梗死患者動脈狹窄的程度、分布特征、側(cè)支循環(huán)建立情況進(jìn)行評估，以及側(cè)支循環(huán)與神經(jīng)功能缺損的關(guān)系進(jìn)行初步分析，旨在進(jìn)一步探討前循環(huán)系統(tǒng)狹窄或閉塞腦梗死患者側(cè)支循環(huán)的形成與臨床相關(guān)因素的關(guān)系。 方法：選擇2012年1月～2014年1月南昌大學(xué)第一附屬醫(yī)院收治的急性缺血性卒中并且有頸內(nèi)動脈或者大腦中動脈病變的，準(zhǔn)備進(jìn)一步治療（行動脈搭橋、頸內(nèi)動脈支架或者頸內(nèi)動脈剝脫）的112例患者作為研究對象。所有入組患者均完善一般資料的采集，完善頭顱MRA及頸動脈彩超、DSA等影像學(xué)檢查，完善血糖、血脂等生化檢查，進(jìn)行NIHSS評分，以有側(cè)支循環(huán)52例患者為實(shí)驗(yàn)組，無側(cè)支循環(huán)60例患者為對照組，比較兩組之間的血管狹窄部位，狹窄程度、神經(jīng)功能缺損程度，以及腦梗死危險(xiǎn)因素對側(cè)支循環(huán)建立的影響。使用SPSS19.0統(tǒng)計(jì)軟件行數(shù)據(jù)錄入及結(jié)果輸出，以P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果：①入選的112例患者中男性66例，女性46例，有側(cè)支循環(huán)組男性32例，女性20例，無側(cè)支循環(huán)組男性34例，女性26例，年齡最小37歲，最大80歲，平均年齡56.90±11.39，男女性別之間無統(tǒng)計(jì)學(xué)差別。②112例病例中，共檢出病變血管130處，其中顱內(nèi)血管病變86處，顱外血管病變44處，狹窄88處，閉塞42處，頸總動脈分布有15處，頸內(nèi)動脈病變有48處，大腦中動脈有67處。52例建立側(cè)支循環(huán)病例中，以前交通開放最多，有20例，后交通開放12例，前后交通均開放8例，眼動脈開放4例，軟腦膜開放8例。③兩組之間的狹窄程度及部位均有差別，P0.05，隨著狹窄程度的增加，側(cè)支循環(huán)增加。④兩組之間的NIHSS評分比較，有側(cè)支循環(huán)組NIHSS評分較無側(cè)支循環(huán)組明顯降低，有差異性，P0.05，側(cè)支循環(huán)改善腦梗死臨床癥狀。⑤對有意義的危險(xiǎn)因素進(jìn)行多因素Logistic回歸分析，顯示高血壓促進(jìn)側(cè)支循環(huán)形成，，高血糖、高血脂、高同型半胱氨酸等均不利于側(cè)支循環(huán)的形成。 結(jié)論： 1、前循環(huán)梗死動脈病變好發(fā)于顱內(nèi)段，且多見于大腦中動脈。 2、側(cè)支循環(huán)開放與腦動脈狹窄程度相關(guān)，狹窄程度越重，側(cè)支循環(huán)開放越充分。 3、側(cè)支循環(huán)對缺血腦組織有保護(hù)作用，能改善腦梗死臨床癥狀，減少梗死體積。 4、側(cè)支循環(huán)形成時(shí)，首先開放的是初級側(cè)支循環(huán)，以前交通開放為主。 5、側(cè)支循環(huán)的形成受多因素的影響，高血壓促進(jìn)側(cè)支循環(huán)的形成，而高血糖、吸煙、高血脂、高同型半胱氨酸等均不利于側(cè)支循環(huán)的形成。
[Abstract]:Objective: to evaluate the degree, distribution and establishment of collateral circulation in patients with cerebral infarction caused by anterior circulatory system angiopathy by digital subtraction angiography. The relationship between collateral circulation and nerve function defect was analyzed in order to explore the relationship between collateral circulation and clinical factors in patients with anterior circulatory stenosis or occlusion. Methods: from January 2012 to January 2014, patients with acute ischemic stroke treated in the first affiliated Hospital of Nanchang University with lesions of internal carotid artery or middle cerebral artery were selected for further treatment. 112 patients with internal carotid artery stents or internal carotid artery exfoliation were studied. All the patients in the group improved the collection of general data, the imaging examination of head MRA and carotid artery color Doppler ultrasound, and the biochemical examination of blood glucose, blood lipid, etc. NIHSS score was performed in 52 patients with collateral circulation and 60 patients without collateral circulation as control group. And the influence of risk factors of cerebral infarction on the establishment of collateral circulation. Using SPSS19.0 statistical software data input and result output, P0.05 as the difference was statistically significant. Results among 112 patients, 66 were male, 46 were female, 32 were male and 20 female in collateral circulation group, 34 were male and 26 female in non-collateral circulation group, the youngest was 37 years old and the oldest was 80 years old. The mean age was 56.90 鹵11.39.The mean age was 56.90 鹵11.39.The mean age was 56.90 鹵11.39.The mean age was 56.90 鹵11.39.The mean age was 56.90 鹵11.39.The mean age was 56.90 鹵11.39.The mean age was 56.90 鹵11.39.The mean age was 56.90 鹵11.39.The mean age was 56.90 鹵11.39.The mean age was 56.90 鹵11.39@@. There were 48 lesions in the internal carotid artery, 67 in the middle cerebral artery and 52 in the establishment of collateral circulation. In the past, there were 20 cases of open communication, 12 cases of posterior communication, 8 cases of anterior and posterior communicating, 4 cases of open ophthalmic artery. There were significant differences in the degree and location of stenosis between the two groups (P 0.05). With the increase of the stenosis degree, the collateral circulation increased the NIHSS score between the two groups. The NIHSS score of the collateral circulation group was significantly lower than that of the non-collateral circulation group. Logistic regression analysis showed that hypertension promoted collateral circulation, hyperglycemia and hyperlipidemia. High homocysteine is not conducive to the formation of collateral circulation. Conclusion:. 1. Arteriopathy of anterior circulation infarction is more common in intracranial segment, and is more common in middle cerebral artery. 2. The opening of collateral circulation is related to the degree of cerebral artery stenosis. 3, collateral circulation has protective effect on ischemic brain tissue, can improve clinical symptoms of cerebral infarction and reduce infarct volume. 4. When collateral circulation was formed, primary collateral circulation was first opened, and traffic was mainly opened before. 5. The formation of collateral circulation was affected by many factors. Hypertension promoted the formation of collateral circulation, while hyperglycemia, smoking, hyperlipidemia and homocysteine were not conducive to the formation of collateral circulation.
【學(xué)位授予單位】：南昌大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R743.3

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