本文選題：隱源性卒中　切入點(diǎn)：卵圓孔未閉　出處：《鄭州大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的比較伴卵圓孔未閉(PFO)卒中患者與無(wú)卵圓孔未閉的隱源性卒中(CS)患者的影像學(xué)表現(xiàn),以期發(fā)現(xiàn)PFO相關(guān)卒中的特定影像學(xué)特征,有助于對(duì)歸因于PFO的隱源性卒中的病因?qū)W診斷。方法分析2013年1月至2016年4月在鄭州大學(xué)人民醫(yī)院就診的發(fā)病2周內(nèi)的隱源性卒中(急性腦梗死或短暫性腦缺血發(fā)作)患者,均行經(jīng)食管超聲心動(dòng)圖右心聲學(xué)造影(cTTE)或經(jīng)食管超聲心動(dòng)圖(TEE)檢查,共納入患者70例,根據(jù)有無(wú)伴發(fā)卵圓孔未閉分為兩組,PFO(+)隱源性卒中組40例,PFO(-)隱源性卒中組30例;收集臨床一般資料:年齡、性別、發(fā)病至檢查時(shí)間、腦血管病危險(xiǎn)因素(高血壓病、糖尿病、心臟病、吸煙史、飲酒史)、有無(wú)偏頭痛、入院NIHSS評(píng)分;分析彌散加權(quán)成像(DWI)上的腦梗死灶的梗死類型(數(shù)量、位置、大小)、梗死灶責(zé)任血管分布區(qū)域、有無(wú)顱內(nèi)動(dòng)脈狹窄、既往有無(wú)腦梗死病史等,進(jìn)行組間差異的比較,并進(jìn)行偏頭痛與PFO(+)卒中相關(guān)性檢驗(yàn)。結(jié)果70例患者中,男性51例,女性19例,平均年齡為36.54±12.14;兩組間一般臨床資料差異無(wú)統(tǒng)計(jì)學(xué)意義。偏頭痛在PFO相關(guān)性卒中患者發(fā)病率多于PFO(-)CS患者,差異有統(tǒng)計(jì)學(xué)意義(15%vs 0%,P=0.027);PFO(+)卒中的在DWI上的梗死類型多為多血管分布區(qū)域的多發(fā)梗死灶(25%vs.6.7%,P=0.004),梗死灶更多分布于椎基底動(dòng)脈系統(tǒng)(40%vs.16.7%,P=0.035),尤其是大腦后動(dòng)脈區(qū)域(44.5%vs.10%,P=0.016)。相反,PFO(-)的CS多見(jiàn)于單血管區(qū)域的大于15mm的融合性病灶(30%vs.7.5%,P=0.013),分布于左側(cè)頸內(nèi)動(dòng)脈最常見(jiàn)(46.7%vs.20.0%,P=0.017);PFO(+)卒中與偏頭痛顯著相關(guān)(χ2=5.216,P=0.022)。結(jié)論1.多血管分布區(qū)域的多發(fā)梗死灶且后循環(huán)梗死占優(yōu)勢(shì)的急性腦梗死其發(fā)病機(jī)制應(yīng)考慮為PFO相關(guān)的反常栓塞;2.隱源性卒中梗死灶在DWI上表現(xiàn)為單血管分布區(qū)域的融合性病灶(15mm)考慮為非PFO相關(guān)的隱源性腦梗死。3.偏頭痛與PFO(+)卒中具有相關(guān)性,提示伴偏頭痛的隱源性腦梗死患者需常規(guī)進(jìn)行PFO的篩查。
[Abstract]:Objective to compare the imaging findings of patients with patent foramen ovale (PFOO) and cryptogenic apoplexy (CSS) without patent foramen ovale in order to find the specific imaging features of PFO related stroke. Methods from January 2013 to April 2016, patients with cryptogenic stroke (acute cerebral infarction or transient ischemic attack) who were admitted to the people's Hospital of Zhengzhou University from January 2013 to April 2016 were analyzed. All patients were examined by transesophageal echocardiography (cTTEE) or transesophageal echocardiography (TEE). According to the presence or absence of patent foramen ovale, they were divided into two groups: PFO-PFO-PFO-induced stroke group (30 cases). General clinical data were collected: age, sex, time from onset to examination, risk factors of cerebrovascular disease (hypertension, diabetes, heart disease, smoking history, alcohol history, migraine, admission NIHSS score). The types of cerebral infarction (number, location, size, distribution of responsible vessels, stenosis of intracranial artery and history of cerebral infarction) on DWI were analyzed, and the differences between the two groups were compared. Results among 70 patients, 51 were male and 19 were female. The average age was 36.54 鹵12.14. There was no significant difference in general clinical data between the two groups. The incidence of migraine in patients with PFO related stroke was higher than that in patients with PFO(-)CS. The type of infarction on DWI was 25vs.6.7% P0.004, and the infarct was distributed in the vertebrobasilar artery system 40vs.16.7P0.035, especially in the area of posterior cerebral artery (44.5vs.10P 0.016). More than 15mm fusion lesion was found in single vessel area, which was more than 15mm. Conclusion: 1. Multiple infarct and posterior circulation infarction in multi-vessel distribution area are most common in the left internal carotid artery, 46.7 vs.20.0. 0 PFOO (PFOO) stroke is significantly associated with migraine (蠂 2 25.216P0.0222.Conclusion 1. Multi-vessel distribution area with multiple infarct and posterior circulation infarction is dominant. The pathogenesis of acute cerebral infarction should be considered as PFO related abnormal embolism 2.The infarct focus of cryptogenic apoplexy on DWI is presented as a fusion lesion with a single vascular distribution area (15 mm). (3) Migraine and migraine are associated with cryptogenic cerebral infarction. PFOO () stroke has a correlation, The results suggest that PFO screening should be performed routinely in patients with migraine cryptogenic cerebral infarction.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R743.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 肖雨雄;鄧蕓;劉純鋼;梁愛(ài)群;;經(jīng)食管超聲心動(dòng)圖對(duì)老年卵圓孔未閉患者的研究分析[J];中國(guó)現(xiàn)代藥物應(yīng)用;2016年11期

2 蘭春偉;尉娜;殷闖;張合喜;李俊娜;栗延偉;張軍艷;譚軍;;中青年隱源性腦梗死合并卵圓孔未閉患者臨床及影像特點(diǎn)分析[J];中風(fēng)與神經(jīng)疾病雜志;2016年04期

3 王英莉;張娜;郭朋悅;張軍;吳利杰;;右心聲學(xué)造影對(duì)卵圓孔未閉右向左分流的檢出情況[J];心臟雜志;2016年03期

4 韓藝華;邢英琦;陳嘉峰;;隱源性卒中病因?qū)W最新研究進(jìn)展[J];中國(guó)卒中雜志;2015年08期

5 馮美瓊;李慶明;;多排螺旋CT頭頸部血管成像掃描技術(shù)的應(yīng)用[J];醫(yī)療衛(wèi)生裝備;2012年10期

6 吳美華;李華泰;;卵圓孔未閉的研究進(jìn)展[J];心血管病學(xué)進(jìn)展;2007年01期

7 Kizer J.R;Devereux R.B.;馬超;;卵圓孔未閉與年輕人不明原因腦卒中[J];世界核心醫(yī)學(xué)期刊文摘(心臟病學(xué)分冊(cè));2006年05期

8 劉春嶺,黃如訓(xùn),解龍昌,林健雯,朱良付,師曉耕;3059例卒中危險(xiǎn)因素20年回顧性分析[J];中國(guó)腦血管病雜志;2005年01期

，

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