本文選題：缺血性腦血管病　切入點：頸動脈斑塊　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:通過應(yīng)用頸動脈斑塊的超聲造影(contrast-enhanced ultrasonography,CEUS)檢查技術(shù),觀察并比較聯(lián)合應(yīng)用阿托伐他汀與普羅布考和單獨應(yīng)用阿托伐他汀兩種治療方法對缺血性腦血管病(ischemic cerebrovasular disease,ICVD)患者頸動脈斑塊穩(wěn)定性的影響,并觀察比較兩種治療方法對患者ICVD復(fù)發(fā)率、臨床癥狀的改善及其生活自理能力方面的影響,從而綜合評價對比兩種治療方法的臨床療效;通過分析比較超聲造影與常規(guī)超聲對頸動脈斑塊的探查結(jié)果,比較兩種檢查技術(shù)的優(yōu)劣。方法:篩選并收集2015年7月-2016年12月于河北醫(yī)科大學(xué)第二醫(yī)院神經(jīng)內(nèi)科住院的ICVD患者,共68例,入組患者治療前均通過頭顱核磁共振技術(shù)(magnetic resonance imaging,MRI)證實為缺血性腦血管病,且均進行了頸動脈常規(guī)超聲及超聲造影檢查,行超聲造影檢查前被檢查者均無嚴重心肺疾病及其他造影禁忌證且簽署超聲造影知情同意書。符合入組標(biāo)準(zhǔn)的患者應(yīng)用擲硬幣法隨機分為A、B兩組,A組33例,B組35例,A組治療采用聯(lián)合應(yīng)用阿托伐他汀與普羅布考(阿托伐他汀鈣片20mg 1/日、普羅布考片0.25g早、晚餐時服用2/日)及其他ICVD的常規(guī)治療,B組治療采用單獨應(yīng)用阿托伐他汀(阿托伐他汀鈣片20mg 1/日)及其他ICVD的常規(guī)治療。4個月后對A、B兩組病例復(fù)查頸動脈超聲造影并進行隨訪記錄,觀察并對比A、B兩組患者治療前后頸動脈斑塊穩(wěn)定性的變化、NIHSS評分的變化以及ICVD的復(fù)發(fā)率。收集治療前A、B兩組患者頸動脈常規(guī)超聲及超聲造影檢查圖像,對比并分析總結(jié)兩種檢查方法的特點。結(jié)果:1斑塊穩(wěn)定性比較經(jīng)治療4個月后,比較兩組患者治療前后的頸動脈斑塊穩(wěn)定性等級好轉(zhuǎn)情況,A、B兩組患者頸動脈斑塊穩(wěn)定性等級均顯著好轉(zhuǎn),與B組相比,A組患者頸動脈斑塊穩(wěn)定性等級顯著好轉(zhuǎn),差異有統(tǒng)計學(xué)意義。2 NIHSS評分比較經(jīng)4個月治療后,比較兩組患者治療前后的NIHSS評分變化情況,A、B兩組NIHSS評分水平均顯著降低,但兩組間差異無統(tǒng)計學(xué)意義。3 ICVD復(fù)發(fā)率比較治療4個月后,A組30例患者中有1例復(fù)發(fā);B組30例患者中有5例復(fù)發(fā);A、B兩組患者ICVD復(fù)發(fā)率的差異有統(tǒng)計學(xué)意義,A組患者較B組患者的ICVD復(fù)發(fā)率低。4頸動脈常規(guī)超聲及超聲造影檢查對比在入組的60例患者中,存在8例患者超聲造影證實斑塊分級僅為Ⅰ級但常規(guī)超聲提示為低回聲;5例患者超聲造影證實斑塊分級為Ⅲ-Ⅳ級但常規(guī)超聲提示高回聲;4例患者的超聲造影圖像顯示出常規(guī)超聲未能清晰探及的位于頸內(nèi)動脈外側(cè)壁的斑塊。結(jié)論:對于存在頸動脈斑塊的缺血性腦血管病患者,在穩(wěn)定頸動脈斑塊、改善臨床癥狀及其生活自理能力和降低缺血性腦血管病的復(fù)發(fā)率方面,聯(lián)合應(yīng)用阿托伐他汀與普羅布考療效優(yōu)于單獨應(yīng)用阿托伐他汀;頸動脈超聲造影技術(shù)在診斷頸動脈粥樣硬化斑塊,尤其是在發(fā)現(xiàn)頸動脈外側(cè)壁斑塊、觀察斑塊內(nèi)新生血管及評估斑塊穩(wěn)定性方面優(yōu)于常規(guī)超聲技術(shù)。
[Abstract]:Objective: through the application of contrast-enhanced ultrasound of carotid plaque (contrast-enhanced ultrasonography CEUS) technique, were observed and compared with atorvastatin and probucol atorvastatin alone and two kinds of treatment of ischemic cerebrovascular disease (ischemic cerebrovasular disease, ICVD) influence the stability of carotid plaque in patients, and compare the two methods to treat patients with ICVD recurrence rate of the observation, the improvement of self-care ability to influence life and clinical symptoms, clinical curative effect and comprehensive evaluation comparison of two treatment methods; through the analysis and comparison of the exploration results of contrast-enhanced ultrasound and conventional ultrasound on carotid artery plaque, comparison of two kinds of inspection technical merits. Method: screening and collection of July 2015 -2016 in December to ICVD patients in the Department of Neurology, the second hospital of Hebei Medical University, a total of 68 cases, the patients before the treatment by Cranial magnetic resonance technology (magnetic resonance imaging, MRI) confirmed ischemic cerebrovascular disease, and underwent carotid artery ultrasound and contrast-enhanced ultrasound, contrast-enhanced ultrasound examination before the patients have no serious heart and lung disease and other contraindications contrast ultrasound contrast and signed informed consent. Eligible patients application of coin were randomly divided into A, B two groups, A group of 33 cases, 35 cases of B group, A group treated with atorvastatin and probucol (1/, Atorvastatin Calcium Tablets 20mg, Probucol Tablets 0.25g early dinner taking 2/ day) and other conventional treatment ICVD, treatment group B used alone atorvastatin (Atorvastatin Calcium Tablets 20mg 1/) and other conventional treatment.4 ICVD months after the A, B group two cases of internal carotid artery ultrasonography and follow-up records, observation and comparison of A, B before and after treatment in two groups of carotid artery Changes in the stability of artery plaque, the change of NIHSS score and the recurrence rate of ICVD. A B collected before treatment, two groups of patients with carotid artery ultrasound and contrast-enhanced ultrasound image characteristics, contrast and analyze the two methods. Results: compared with 1 plaques after 4 months of therapy, the stability of carotid plaque grade two groups were compared before and after treatment of the situation improved, A, B two groups of patients with carotid artery plaque stability grade were significantly improved, compared with the B group, A group of patients with carotid artery plaque stability grade improved significantly, there were statistically significant differences in.2 NIHSS score 4 months after treatment, NIHSS score changes were compared before and after two. Groups A, B and NIHSS scores of the two groups were significantly decreased, but the difference between the two groups was not statistically significant.3 ICVD to compare the recurrence rate after 4 months of treatment, 1 cases recurred in 30 patients in the A group; B group of 30 patients in 5 cases Recurrence; A, the difference was statistically significant in two groups of B patients with ICVD recurrence rate, patients in the A group compared with B group, ICVD in patients with low recurrence rate.4 of carotid artery ultrasound angiography in 60 patients, 8 patients had confirmed ultrasound plaque classification only grade but regular ultrasound showed hypoechoic; 5 cases were confirmed as ultrasound contrast plaque grade III - IV but conventional ultrasound showed high echo; 4 cases of patients with contrast-enhanced ultrasonography showed conventional ultrasound probe and failed to clear in the lateral wall of the carotid artery plaque. Conclusion: in the presence of carotid plaque in patients with ischemic cerebrovascular disease in the stable, carotid artery plaque, improve clinical symptoms and self-care ability and reduce the recurrence rate of ischemic cerebrovascular disease, combined with atorvastatin and probucol curative effect is better than the single application of carotid artery ultrasound made Ato Vatatin; It is superior to conventional ultrasound in the diagnosis of carotid atherosclerotic plaques, especially in finding the lateral wall plaque of carotid artery, observing the neovascularization in plaques and evaluating the stability of plaques.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R743

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