本文選題：短暫性腦缺血發(fā)作　切入點：頸動脈狹窄　出處：《新鄉(xiāng)醫(yī)學院》2014年碩士論文　論文類型：學位論文

【摘要】：背景短暫性腦缺血發(fā)作(transient ischemic attack, TIA)是指腦血管病變(頸動脈或椎-基底動脈系統(tǒng)發(fā)生短暫性血液供應不足),引起局灶性腦缺血導致突發(fā)的、短暫性、可逆性神經(jīng)功能障礙,可能進展為完全性腦梗死,是繼發(fā)腦卒中的常見預警信號。頸動脈粥樣硬化狹窄是TIA和腦卒中常見病因。目的收集頸動脈狹窄性TIA患者的臨床資料,并通過隨訪調(diào)查,以頸動脈狹窄性TIA患者進展為腦梗死或死亡為終點事件,通過隊列研究,尋找出頸動脈狹窄性TIA患者進展為腦梗死的危險因素,提高對頸動脈狹窄性TIA進展為腦梗死的危險性及預后的認識,以便實施早期干預、制定有效治療方案,系統(tǒng)性治療,降低患者不良預后發(fā)生率。方法收集我院自2008年5月至2009年6月收治的126例經(jīng)頸部血管彩超明確有頸動脈狹窄的TIA患者的臨床資料,隨訪5年。以繼發(fā)腦梗死或死亡為終點事件,分為繼發(fā)腦梗死組與無繼發(fā)腦梗死組,比較兩組患者間的臨床資料,包括一般常規(guī)資料：患者年齡、性別、既往糖尿病史、既往高血壓病史、既往吸煙史(吸煙指數(shù))；入院時常規(guī)生化指標：包括總淋巴細胞計數(shù)、血紅蛋白、C-反應蛋白、纖維蛋白原、血小板計數(shù)、低密度脂蛋白膽固醇水平、肌酐水平、國際標準化比值；影像學資料：頸動脈狹窄程度,并采用ABCD2評估方法,對兩組資料進行比較,尋找頸動脈狹窄性TIA進展為腦梗死的危險因素。同時選擇同時期48例無TIA發(fā)作頸動脈狹窄性腦梗死患者,作為繼發(fā)腦梗死組的另一對比組,比較兩組間的臨床資料,總結頸動脈狹窄性TIA繼發(fā)腦梗死相關危險因素,對比兩組間患者神經(jīng)功能缺損程度及對應預后分級,探討頸動脈狹窄性TIA后腦梗死患者的預后。結果對比兩組資料,繼發(fā)腦梗死組合并高血壓病史15人(17.24%)較無繼發(fā)腦梗死組5人(12.82%)高,p0.05,差異有統(tǒng)計學意義；繼發(fā)腦梗死組合并糖尿病史12人(13.79%)較無繼發(fā)腦梗死組3人(7.69%)高,p0.05,差異有統(tǒng)計學意義；繼發(fā)腦梗死組平均吸煙指數(shù)400者31人(35.63%)較無繼發(fā)腦梗死組10人(25.64%)高,p0.05,差異有統(tǒng)計學意義,繼發(fā)腦梗死組發(fā)作60min者占30人(34.48%)較無繼發(fā)腦梗死組7人(17.95%)高,有統(tǒng)計學差異。繼發(fā)腦梗死組以及無繼發(fā)腦梗死組在ABCD2平均評分分別為：5.00分、3.17分,兩組x2檢驗,p0.05,差異有統(tǒng)計學意義。在常規(guī)生化指標上繼發(fā)腦梗死組,患者的血小板計數(shù)、纖維蛋白原水平均較無繼發(fā)腦梗死組高,兩者比較,p0.05,兩組在頸動脈狹窄程度上,繼發(fā)腦梗死組重度和頸動脈閉塞比率比無繼發(fā)腦梗死組高,兩者比較,p0.05,有統(tǒng)計學差異。繼發(fā)腦梗死組與無TIA腦梗死組在一般資料項目中,繼發(fā)腦梗死組患者高血壓病史比率、低密度脂蛋白水平較無TIA腦梗死組要低,p0.05,有統(tǒng)計學差異。繼發(fā)腦梗死組與無TIA腦梗死組,兩組GCS評分、神經(jīng)功能缺損程度、預后分級上,繼發(fā)腦梗死組重癥病人要比無TIA腦梗死組多,p0.05,有統(tǒng)計學差異(p0.05)。結論TIA合并頸動脈狹窄繼發(fā)腦梗死風險高,合并頸動脈狹窄TIA后腦梗死相關危險因素包括年齡60歲、高血壓病、糖尿病、發(fā)病持續(xù)時間60min、吸煙指數(shù)400、血小板計數(shù)升高、低密度脂蛋白水平升高、纖維蛋白原水平升高以及頸動脈狹窄程度。頸動脈狹窄性TIA患者繼發(fā)腦梗死預后差。
[Abstract]:The background of transient ischemic attack (transient ischemic, attack, TIA) is a cerebral vascular disease (carotid or vertebrobasilar transient blood supply), caused by focal cerebral ischemia leads to sudden, transient, reversible neurological dysfunction, may progress to complete cerebral infarction is a common early warning signal secondary stroke. Carotid artery stenosis is a common cause of stroke and TIA. The clinical data collection of patients with carotid artery stenosis of TIA, and through the follow-up survey, with the progress of TIA for patients with carotid artery stenosis cerebral infarction or death as the end point events, through the cohort study, find out the progress of patients with carotid artery stenosis TIA the risk factors of cerebral infarction, improve the carotid artery stenosis TIA progress to know the risk and prognosis of cerebral infarction, in order to implement the early intervention, to develop effective treatment programs, treatment system, Reduce the incidence of adverse prognosis. The neck vascular ultrasound methods in our hospital from May 2008 to June 2009 were 126 cases of clear clinical data of carotid artery stenosis in patients with TIA and followed up for 5 years. In the secondary cerebral infarction or death as the end point event, divided into cerebral infarction group and non cerebral infarction group. The clinical data were compared between the two groups among the patients, including general information: age, gender, history of diabetes, history of hypertension, history of smoking (smoking index); admission of conventional biochemical indicators include: total lymphocyte count, hemoglobin, C- reactive protein, fibrinogen, platelet count, the level of low density lipoprotein cholesterol, creatinine levels. The international normalized ratio; imaging data: the degree of carotid artery stenosis, and by ABCD2 evaluation method, to compare the two groups of data, looking for the progress of carotid artery stenosis TIA The risk factors of cerebral infarction. At the same time, select the same period in 48 cases of non TIA patients with carotid artery stenosis cerebral infarction, as a contrast group and cerebral infarction group, the clinical data were compared between the two groups, then the related risk of carotid artery stenosis of TIA cerebral infarction secondary factors, comparison between the two groups of patients with neurological impairment and prognosis of the corresponding classification to explore the prognosis of carotid artery stenosis, TIA of patients with cerebral infarction. Results compared with two groups of data, and a history of hypertension and cerebral infarction of 15 people (17.24%) with no secondary cerebral infarction group of 5 people (12.82%), P0.05, the difference was statistically significant; secondary cerebral infarction combined with diabetes history of 12 people (13.79%) with no secondary cerebral infarction a group of 3 people (7.69%), P0.05, the difference was statistically significant; cerebral infarction group average smoking index 400 31 people (35.63%) with no secondary cerebral infarction group of 10 people (25.64%), P0.05, there was statistically significant difference Yi, secondary cerebral infarction attack 60min accounted for 30 (34.48%) with no secondary cerebral infarction group of 7 people (17.95%), there was statistically significant difference. The secondary cerebral infarction group and no secondary cerebral infarction group in ABCD2 scores were 5 points, 3.17 points, two group x2 test, P0.05, the difference was statistically significant secondary. Cerebral infarction group in the conventional biochemical indicators, platelet count, fibrinogen and no secondary cerebral infarction was higher than the average, the comparison between the two, P0.05, two groups in the degree of carotid artery stenosis, cerebral infarction group and severe carotid artery occlusion ratio without cerebral infarction group, the comparison between the two, P0.05, there were significant differences in secondary. The cerebral infarction group and non cerebral infarction group TIA in the general information project, the group of patients with cerebral infarction secondary hypertension ratio, low density lipoprotein levels than those without TIA in cerebral infarction group to low P0.05, there were significant differences in cerebral infarction group and non T. IA of cerebral infarction group, GCS scores of the two groups, the degree of neurologic impairment and prognosis grading, secondary cerebral infarction group than patients without TIA in cerebral infarction group, there were significant differences (P0.05, P0.05). Conclusion TIA combined with carotid artery stenosis and cerebral infarction with high risk, the risk associated with carotid artery stenosis cerebral infarction TIA factors including age 60 years of age, hypertension, diabetes, disease duration 60min, smoking index 400, platelet count increased, elevated low-density lipoprotein levels, elevated levels of fibrinogen and carotid artery stenosis. The carotid artery stenosis of TIA patients with secondary cerebral infarction with poor prognosis.

【學位授予單位】：新鄉(xiāng)醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R743.3
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本文編號：1648553