本文選題：缺血性腦卒中　切入點：進展性卒中　出處：《吉林大學》2015年碩士論文

【摘要】：目的: 尋找進展性卒中相關(guān)危險因素，為其預(yù)防和治療提供依據(jù)。 方法: 收集吉林大學第二醫(yī)院神經(jīng)內(nèi)科2013年12月—2014年6月住院治療的176例急性腦卒中患者的臨床資料，在患者入院時、病情變化時及發(fā)病7天時分別采用美國國立研究院卒中量表(NationalInstitutes of Stroke in progression Health Stroke Scale，NIHSS）對其進行評分，，根據(jù)評分是否增加3分或3分以上，分為進展性卒中（Strokein progression，SIP）組和非進展性卒中（Not stroke in progression，NSIP）組，其中SIP組52例，NSIP組124例，分析比較兩組患者的一般資料(年齡、性別、吸煙、既往病史、卒中家族史)，入院后體溫、血壓及血壓變化,生化指標(甘油三酯、總膽固醇、低密度脂蛋白膽固醇、尿酸、空腹血糖、纖維蛋白原、D-二聚體、血清同型半胱氨酸)及頭顱電子計算機體層掃描（Computerized tomography，CT）、頭部磁共振成像（Magnetic resonance imaging，MRI）、頭頸部血管彩超、磁共振血管成像（Magnetic resonance angiograpgy，MRA）或CT血管成像（Computerized tomography angiograpgy，CTA）。應(yīng)用SPSS19.0軟件處理數(shù)據(jù),計數(shù)資料的比較行χ2檢驗,計量資料行t檢驗,p0.05有統(tǒng)計學意義。 結(jié)果: 1.共納入缺血型腦卒中患者176例,其中SIP組52例，非SIP組124例。SIP的發(fā)生率為28.4%。 2.比較兩組一般資料，在性別、年齡、吸煙史、腦血管病家族史方面結(jié)果顯示差異均無統(tǒng)計學意義(P0.05)。而高血壓、糖尿病病史在兩組間比較差異有統(tǒng)計學意義(P0.05)。 3.比較兩組患者的纖維蛋白原、D-二聚體、血同型半胱氨酸、甘油三酯、總膽固醇、低密度脂蛋白膽固醇、尿酸，入院后血糖水平，結(jié)果顯示，血糖升高在兩組間比較差異有統(tǒng)計學意義(P0.05)，余因素比較差異均無統(tǒng)計學意義(P0.05)。 4.比較兩組患者入院后發(fā)熱及收縮壓下降，差異均有統(tǒng)計學意義(P＜0.05)。 5.比較兩組患者責任病灶，結(jié)果顯示，分水嶺梗塞（皮層及皮層下分水嶺）及大面積梗塞在兩組間相比差異有統(tǒng)計學意義(P0.05)。 6.比較兩組患者血管方面檢查，結(jié)果顯示，責任血管閉塞、中重度狹窄及存在不穩(wěn)定斑塊在兩組間差異均有統(tǒng)計學意義（P＜0.05）。 7.比較患者頸內(nèi)動脈系統(tǒng)及椎基底動脈系統(tǒng)血管閉塞、中重度狹窄或存在不穩(wěn)定斑塊的情況，結(jié)果顯示，兩者比較差異有統(tǒng)計學意義(P＜0.05)。 結(jié)論: 1.SIP的發(fā)生率為28.4%。 2.糖尿病病史以及入院后血糖升高、高血壓病史以及入院后收縮壓下降、卒中后發(fā)熱均為SIP的危險因素。 3.大面積腦梗塞及分水嶺梗塞均易發(fā)生SIP。 4.責任血管閉塞、中重度狹窄及存在不穩(wěn)定斑塊均為SIP重要預(yù)測因素。其中頸內(nèi)動脈系統(tǒng)血管存在閉塞、中重度狹窄或不穩(wěn)定斑塊比椎基底動脈系統(tǒng)血管存在上述情況更易進展。
[Abstract]:Objective:. To search for risk factors related to progressive stroke and provide evidence for prevention and treatment. Methods:. To collect the clinical data of 176 patients with acute stroke hospitalized in Department of Neurology, second Hospital of Jilin University from December 2013 to June 2014. The patients were evaluated by the National Institutes of Stroke in progression Health Stroke scale NIHSS at the time of disease change and 7 days after onset, according to whether the score was increased by 3 points or more. The patients were divided into two groups: strokein progression sip group and non progressive stroke group (not stroke in progression group). There were 52 patients in SIP group and 124 patients in SIP group. The general data (age, sex, smoking, past medical history, family history of stroke, body temperature after admission) were analyzed and compared between the two groups. Blood pressure and changes in blood pressure, biochemical parameters (triglyceride, total cholesterol, low density lipoprotein cholesterol, uric acid, fasting blood glucose, fibrinogen D-dimer), Serum homocysteine) and computed tomography computed tomography (CTA), head magnetic resonance imaging, head and neck vascular color ultrasound, magnetic resonance angiograpgyography (MRAA) or computed tomography computed tomography (CTA). The count data were compared by 蠂 2 test, and measured data by t test (p 0.05) were statistically significant. Results:. 1. A total of 176 patients with ischemic stroke were included, including 52 cases in SIP group and 124 cases in non-#en1# group. The incidence rate of SIP was 28.4%. 2.Compared with the general data of the two groups, there was no significant difference in sex, age, smoking history, family history of cerebrovascular diseases, but there was significant difference in the history of hypertension and diabetes between the two groups (P 0.05). 3. The levels of fibrinogen D-dimer, homocysteine, triglyceride, total cholesterol, low density lipoprotein cholesterol, uric acid, blood glucose after admission were compared between the two groups. There was significant difference in blood glucose between the two groups (P 0.05), but there was no significant difference in the other factors between the two groups (P 0.05). 4. The difference of fever and systolic blood pressure between the two groups was statistically significant (P < 0.05). 5. The results showed that watershed infarction (cortical and subcortical watershed) and large area infarction were significantly different between the two groups (P 0.05). 6.Compared with the blood vessel examination of the two groups, the results showed that the responsible vessel occlusion, moderate and severe stenosis and the existence of unstable plaques were significantly different between the two groups (P < 0.05). 7. The internal carotid artery system and vertebrobasilar artery system were compared in the patients with occlusion, moderate and severe stenosis or unstable plaque. The results showed that there was significant difference between the two groups (P < 0.05). Conclusion:. The incidence of 1.SIP was 28. 4%. 2. Diabetes history, hyperglycemia after admission, hypertension, systolic blood pressure after admission and fever after stroke were all risk factors of SIP. 3. Large area cerebral infarction and watershed infarction are prone to SIPs. 4. Responsible vascular occlusion, moderate and severe stenosis and unstable plaque were important predictors of SIP. Moderate and severe stenosis or unstable plaques are more likely to progress than vertebrobasilar arteries.
【學位授予單位】：吉林大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R743.3

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