本文選題：缺血性腦損傷　切入點(diǎn)：腦卒中　出處：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的缺血性腦卒中患者急性期多伴隨認(rèn)知、睡眠和自主神經(jīng)功能狀況紊亂及障礙,有關(guān)腦卒中損傷部位與此類并發(fā)癥相關(guān)關(guān)系的研究較多,得出的結(jié)論也各不相同,主要研究有大腦半球?qū)ΨQ性、損傷容積、損傷前界距額極距離、皮質(zhì)或皮質(zhì)下?lián)p傷、腦萎縮等諸多方面。大多數(shù)研究認(rèn)為,腦卒中梗死灶部位與認(rèn)知功能障礙存在一定內(nèi)在聯(lián)系。本研究旨在通過(guò)分析、比較缺血性腦卒中患者不同部位卒中后認(rèn)知功能狀況,探討缺血性腦卒中急性期不同卒中部位與出現(xiàn)的認(rèn)知功能障礙之間的關(guān)系,觀察不同部位病變所致認(rèn)知功能障礙的特點(diǎn)。 方法收集118例腦梗死患者資料,包括額葉17例,顳葉14例,頂葉13例,枕葉10例,基底節(jié)24例,丘腦19例,小腦11例,腦干10例。記錄、統(tǒng)計(jì)并分析患者相關(guān)資料包括年齡、性別、受教育程度等。采用中文版蒙特利爾認(rèn)知評(píng)估量表(Montreal Cognitive Assessment, MoCA)對(duì)118例腦梗死患者進(jìn)行測(cè)試,由受過(guò)專業(yè)培訓(xùn)的神經(jīng)心理測(cè)驗(yàn)員在安靜的房間內(nèi)對(duì)患者進(jìn)行評(píng)分,所有測(cè)驗(yàn)均1次完成,將腦梗死患者的CT/MRI定位與MoCA的7個(gè)分項(xiàng)目,包括定向力(ORT)、視空間與執(zhí)行功能(EF)、命名(NAM)、記憶(MEM,包括瞬時(shí)記憶及近記憶)、注意(ATT)、語(yǔ)言功能(LANG,包括復(fù)述與流暢性)、抽象概括(ABS)的測(cè)試結(jié)果進(jìn)行相關(guān)分析。將上述測(cè)得數(shù)據(jù)應(yīng)用SPSS17.0統(tǒng)計(jì)軟件進(jìn)行分析,計(jì)數(shù)資料應(yīng)用卡方檢驗(yàn),計(jì)量資料應(yīng)用t檢驗(yàn)、方差分析,相關(guān)分析進(jìn)行Logistic多因素逐步回歸分析和Pearson相關(guān)系數(shù)檢驗(yàn)。p0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果(1)118例腦梗死患者資料與認(rèn)知障礙統(tǒng)計(jì)分析結(jié)果提示患者腦梗死的年齡、性別及受教育年限比較無(wú)顯著性差異；(2)額葉組及丘腦組認(rèn)知障礙發(fā)生率最高,達(dá)90%以上；其次為顳葉組,將近80%以上；小腦組及腦干組最低,將近30%；經(jīng)Logistic回歸分析發(fā)現(xiàn),額葉卒中與認(rèn)知功能障礙的發(fā)生密切相關(guān)(P0.01),顳葉、頂葉、枕葉、基底節(jié)、丘腦卒中與認(rèn)知功能障礙的發(fā)生相關(guān)(P0.05),小腦、橋腦卒中與認(rèn)知功能障礙的發(fā)生無(wú)關(guān)(P0.05),不同部位腦梗死患者認(rèn)知障礙發(fā)生率有顯著性差異(p0.005)。(3)經(jīng)Pearson相關(guān)系數(shù)檢驗(yàn)分析基底節(jié)卒中MoCA各分測(cè)驗(yàn)均有損害,其中EF、MEM、LANG損害明顯,額葉卒中ORT、EF、MEM、ATT有明顯損害,頂葉卒中EF、NAM、MEM、ATT損害明顯,顳葉卒中以EF、MEM、LANG損害為主,枕葉卒中主要損害EF,丘腦卒中MEM、LANG損害明顯,小腦卒中可累及LANG,腦橋卒中可累及EF。 結(jié)論不同部位腦梗死患者急性期認(rèn)知障礙的發(fā)生率及認(rèn)知障礙功能損害的特點(diǎn)不同；不同認(rèn)知功能障礙的發(fā)生與腦梗死的部位存在緊密相關(guān)性。
[Abstract]:Objective in the acute phase of ischemic stroke patients, cognitive, sleep and autonomic nervous function disorders and disorders are often associated. The relationship between the location of stroke injury and such complications has been studied and the conclusions are different.There are many aspects such as the symmetry of cerebral hemisphere, the volume of injury, the distance between anterior boundary of injury and frontal area, cortical or subcortical injury, brain atrophy and so on.Most studies suggest that there is an intrinsic relationship between the location of cerebral infarction and cognitive impairment.The purpose of this study was to compare the cognitive function of patients with ischemic stroke after stroke at different locations, and to explore the relationship between different stroke sites and cognitive dysfunction in acute stage of ischemic stroke.To observe the characteristics of cognitive dysfunction caused by different lesions.Methods 118 cases of cerebral infarction were collected, including 17 cases of frontal lobe, 14 cases of temporal lobe, 13 cases of parietal lobe, 10 cases of occipital lobe, 24 cases of basal ganglia, 19 cases of thalamus, 11 cases of cerebellum and 10 cases of brain stem.Record, statistics and analyze patient data including age, sex, education level, etc.The Chinese version of Montreal Cognitive Assessment scale (MoCAA) was used to test 118 patients with cerebral infarction. The patients were scored by trained neuropsychological examiners in a quiet room. All the tests were completed once.The CT/MRI of patients with cerebral infarction was located with 7 subitems of MoCA.It includes orientational force, visual space and executive function, visual space and executive function, Nam, memory, memory, including instantaneous memory and proximal memory, attention to ATT, language function, including repetition and fluency, abstract summary of ABS).The above measured data were analyzed by SPSS17.0 statistical software, the counting data were analyzed by chi-square test, the measurement data were analyzed by t test, and the analysis of variance was made.There were significant differences in Logistic stepwise regression analysis and Pearson correlation coefficient test (p0. 05).Results the data of 118 patients with cerebral infarction and the statistical analysis of cognitive impairment showed that there was no significant difference in age, sex and years of education in patients with cerebral infarction. (2) the incidence of cognitive impairment in frontal lobe group and thalamus group was the highest (over 90%).The second was temporal lobe group (nearly 80%), cerebellar group and brainstem group (nearly 30%). By Logistic regression analysis, it was found that frontal lobe stroke was closely related to cognitive dysfunction (P 0.01), temporal lobe, parietal lobe, occipital lobe, basal ganglia,Thalamic apoplexy is associated with cognitive impairment (P0.05), cerebellum, cerebellum, cerebellum, and cerebellum.There was significant difference in the incidence of cognitive impairment in patients with cerebral infarction at different locations (P < 0.05). The MoCA subtests of basal ganglia stroke were analyzed by Pearson correlation coefficient test.棰濆彾鍗掍腑ORT,EF,MEM,ATT鏈夋槑鏄炬崯瀹，

本文編號(hào)：1711709