本文選題：急性腦梗死　切入點：動態(tài)腦血流自動調(diào)節(jié)　出處：《吉林大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景與目的:動態(tài)腦血流自動調(diào)節(jié)(dynamic cerebral autoregulation,dCA)是一種在血壓在一定范圍內(nèi)快速變化時,大腦通過阻力血管收縮或舒張保持腦血流量相對穩(wěn)定的內(nèi)在機制。急性期腦梗死患者的dCA功能受損與患者不良預(yù)后密切相關(guān),但dCA功能受損的相關(guān)影響因素尚不明確。該研究旨在探究急性腦梗死患者dCA功能受損的相關(guān)危險因素。方法:研究共納入來自吉林大學第一醫(yī)院腦卒中單元的急性單側(cè)前循環(huán)腦梗死患者112例,同時納入年齡、性別與患者組相匹配的健康人50例作為對照組。采用經(jīng)顱多普勒超聲(transcranial Doppler ultrasound,TCD)連續(xù)監(jiān)測受試者的雙側(cè)大腦中動脈(middle cerebral artery,MCA)腦血流速度(cerebral blood flow velocity,CBFV),應(yīng)用無創(chuàng)指尖血壓連續(xù)監(jiān)測法同步監(jiān)測動脈血壓(arterial blood pressure,ABP)。將采集的ABP和CBFV的原始數(shù)據(jù)應(yīng)用傳遞函數(shù)(transfer function analysis,TFA)分析得出定量評估dCA的參數(shù):增益(Gain)和相位差(Phase Difference,PD)。所有患者臨床資料均來源于卒中單元患者數(shù)據(jù)庫。對患者組的PD與臨床因素進行線性回歸分析,得到急性腦梗死患者dCA功能受損的相關(guān)危險因素。結(jié)果:1.患者組的平均年齡為52.18±11.41歲(27 77歲),其中女性15例(13.4%)。NIHSS評分≤3患者59例(52.7%),合并高血壓病史患者57例(50.9%),合并糖尿病患者18例(16.1%),合并腦卒中病史的患者39例(34.8%),既往有吸煙史的患者73例(65.2%),合并患側(cè)腦動脈狹窄患者69例(61.61%),合并健側(cè)腦動脈輕度狹窄患者21例(18.75%)。2.患側(cè)PD(38.14±18.97°)較健側(cè)PD(43.13±15.78°)及健康對照組PD(57.17±13.45°)明顯降低(p0.05),健側(cè)PD亦明顯低于健康對照組PD(p0.001)。3.經(jīng)過線性回歸分析得出,患側(cè)MCA狹窄(p0.001)是患側(cè)大腦半球dCA功能受損的獨立危險因素,LDL-C水平升高是急性腦梗死患者雙側(cè)大腦半球dCA功能受損的獨立危險因素(患側(cè):p=0.04;健側(cè):p=0.012)。4.患側(cè)MCA狹窄與LDL-C水平無交互作用(p0.05)。5.在患側(cè)MCA不同程度狹窄分組中,重度狹窄或閉塞組的患側(cè)PD(29.20±16.50°)較輕度狹窄組患側(cè)PD(46.53±16.94°39.91±22.44)明顯降低(p0.001p=0.039),但較中度狹窄組患側(cè)PD(35.11±17.21°)無顯著差異(p0.05)。結(jié)論:(1)急性單側(cè)前循環(huán)腦梗死患者,不論是否合并顱內(nèi)動脈狹窄,動態(tài)腦血流自動調(diào)節(jié)功能均雙側(cè)受損,患側(cè)受損程度較健側(cè)嚴重。(2)患側(cè)大腦中動脈狹窄是急性腦梗死患者患側(cè)大腦半球動態(tài)腦血流自動調(diào)節(jié)功能受損的相關(guān)危險因素,當其重度狹窄或閉塞時,動態(tài)腦血流自動調(diào)節(jié)功能受損更嚴重。(3)低密度脂蛋白膽固醇升高是急性腦梗死患者雙側(cè)大腦半球動態(tài)腦血流自動調(diào)節(jié)功能受損的相關(guān)危險因素。
[Abstract]:Background & AIM: dynamic cerebral autoregulationdCAA is a kind of dynamic cerebral autoregulationdCAA which changes blood pressure rapidly in a certain range. The internal mechanism of the brain maintaining relatively stable cerebral blood flow through resistance vasoconstriction or relaxation. The impaired dCA function in patients with acute cerebral infarction is closely related to the poor prognosis of the patients. However, the factors related to the impairment of dCA function are not clear. The aim of this study was to investigate the risk factors of dCA dysfunction in patients with acute cerebral infarction. Methods: the study included acute stroke units from the first Hospital of Jilin University. 112 patients with unilateral anterior circulation cerebral infarction, At the same time, A total of 50 healthy subjects of gender matched with the patient group were used as control group. Transcranial Doppler ultrasound (TCD) was used to continuously monitor bilateral middle cerebral artery (MCA) cerebral blood flow velocity and cerebral blood flow velocityCBFV, and noninvasive fingertip blood pressure was used continuously. The method of monitoring arterial blood pressure was used to monitor arterial blood pressure simultaneously. The original data of ABP and CBFV were analyzed by transfer function analysis (TFAA). The parameters of quantitative evaluation of dCA were obtained: gain gain and phase difference phase difference. All the clinical data of patients were derived from apoplexy. Linear regression analysis of PD and clinical factors, Results 1. The average age of patients with acute cerebral infarction was 52.18 鹵11.41 years old or 27 to 77 years old, including 15 women with a score of 13.40.NIHSS 鈮，

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